title: ICSI outcome is significantly better with testicular spermatozoa in patients with necrozoospermia: a retrospective study.
abstract: OBJECTIVE
  To determine whether intracytoplasmic sperm injection (ICSI) outcome with testicular sperm is superior to that of ejaculated sperm in men with incomplete necrozoospermia, defined as sperm viability ≥5 to ≤45%.
  
  
  METHODS
  Retrospective study at a Reproductive Medicine Center of a tertiary referral hospital. A total of 231 couples with male infertility due to incomplete necrozoospermia underwent 342 ICSI cycles with freshly ejaculated sperm (ICSI-ejaculated) and 182 cycles with testicular sperm (ICSI-TESE).
  
  
  RESULTS
  Overall 1624 MII oocytes were injected in the ICSI-ejaculated group with a fertilisation rate of 60.8%, while in ICSI- TESE cycles the fertilisation rate was 59.6% in 874 MII oocytes. The cleavage rate was higher in ICSI-ejaculated cycles than in ICSI-TESE cycles (96.3% versus 92.9%; p = 0.004). However, the pregnancy and implantation rates per cycle were significantly higher in the ICSI-TESE group (67/182, 36.8% versus 68/342, 19.9% (p = 0.0001); and 23.7% versus 12.7% (p = 0.0001), respectively). The miscarriage rate was similar (ICSI-ejaculated 26.5% versus ICSI-TESE 17.9%, p = 0.301). Live birth rate per cycle in the ICSI-ejaculated group was significantly lower than in the ICSI-TESE (13.7% versus 28.6%, p = 0.0001).
  
  
  CONCLUSIONS
  In cases of persistent necrozoospermia, testicular sperm should be favoured over ejaculated sperm. These data call for more research to understand the pathophysiology of refractory necrozoospermia.
authors.affiliation: Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Research Hospital , Rozzano, Milano , Italy .
authors.forename: Luciano
authors.initials: L
authors.lastname: Negri
authors.forename: Pasquale
authors.initials: P
authors.lastname: Patrizio
authors.forename: Elena
authors.initials: E
authors.lastname: Albani
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.forename: Renzo
authors.initials: R
authors.lastname: Benaglia
authors.forename: Marcello
authors.initials: M
authors.lastname: Desgro
authors.forename: Paolo Emanuele
authors.initials: PE
authors.lastname: Levi Setti
mesh_terms: D000328:Adult; D002470:Cell Survival; D004542:Ejaculation; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000166:cytology* / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult