Attrition rates of in vitro fertilization in patients with male factor infertility using testicular sperm

To assess the oocyte to blastocyst attrition rate in patients undergoing in vitro fertilization (IVF) with male factor infertility (MFI) using testicular sperm.

Retrospective cohort study.

Patients who underwent IVF using testicular sperm for MFI between January 1, 2017, and March 23, 2023.

Testicular sperm extraction (TESE) with intracytoplasmic sperm injection.

The fertilization and blastulation outcomes.

A total of 120 IVF cycles using testicular sperm were identified. For comparison, 122 IVF cycles in patients with unexplained infertility who had normal semen analysis and used ejaculated sperm for intracytoplasmic sperm injection were reviewed as a control group. Testicular sperm cycles were further grouped by prognosis on the basis of the indication for TESE: good prognosis (n = 42, obstructive azoospermia); moderate prognosis (n = 67, increased deoxyribonucleic acid fragmentation, prior failed IVF, and recurrent pregnancy loss); and poor prognosis (n = 11, cryptozoospermia or nonobstructive azoospermia). Female baseline characteristics were similar among the groups except for body mass index. The fertilization rate was lower in all TESE groups than in the control group; however, no differences in fertilization rates were noted within the TESE groups (good vs. moderate vs. poor). The blastulation rates were similar between the good-prognosis TESE and control groups. However, the moderate- and poor-prognosis TESE groups had lower blastulation rates than the control group.

This model may help practitioners counsel patients with MFI using testicular sperm to appropriately set expectations for blastocyst outcomes on the basis of the diagnosis.