Comparing blastulation of surgically retrieved sperm with ejaculated sperm in donor oocyte cycles
Amalia Namath1, Kerry Flannagan2, Kyle Le2
1Shady Grove Fertility Center, Rockville, Maryland; National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Objective:
To evaluate availability of usable blastocysts and blastulation from donor oocytes fertilized with surgically retrieved sperm among patients with obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) compared with ejaculated sperm.
Design:
Retrospective cohort study.
Subjects:
Patients who used fresh or frozen donor oocytes with ejaculated or surgically retrieved sperm from January 2011 to August 2024. Patients were excluded if they used donor sperm, conventional insemination, oocyte donors older than the age of 34 years, and/or transferred cleavage-stage embryos.
Exposure:
Use of surgically extracted sperm.
Main Outcome Measures:
The primary outcome was the availability of at least one usable blastocyst per donor oocyte lot. The secondary outcomes were blastulation, fertilization, and outcomes from the first embryo transfer and all subsequent transfers from index cycle including clinical pregnancy and live birth. Sensitivity analysis was performed, restricting the data to only fresh oocytes, only frozen oocytes, and fresh compared with frozen sperm.
Results:
A total of 13,466 donor oocyte cycles were evaluated, 13,248 cycles that used ejaculated sperm and 218 cycles that used surgically retrieved sperm. In cycles using surgically retrieved sperm, the diagnosis of OA comprised 144 cycles, and that of NOA comprised 74 cycles. Notably, the chance of obtaining at least one usable blastocyst per donor oocyte lot was not significantly different when ejaculated sperm (90.1%, n = 11,942) was compared with OA (86.8%; n = 125; adjusted risk ratio [aRR], 0.97; 95% confidence interval [CI], 0.91-1.03) and NOA (87.8%; n = 65; aRR, 0.98; 95% CI, 0.9-1.06) sperm. The blastulation rate was 39.4% with ejaculated sperm compared with 31.3% with OA sperm (aRR, 0.81; 95% CI, 0.73-0.9) and 30.0% with NOA sperm (aRR, 0.76; 95% CI, 0.64-0.91). The fertilization rate also decreased for OA and NOA sperm compared with that for ejaculated sperm. Similar associations were observed in only fresh oocyte and only frozen oocyte subgroup analyses. Pregnancy and live birth outcomes were similar among groups.
Conclusion:
When comparing donor oocytes fertilized with surgically retrieved sperm with ejaculated sperm, the chance of at least one usable blastocyst per donor oocyte lot was similar for each sperm group. However, there was a decreased chance of blastulation and fertilization, even when comparing fresh and frozen gametes.
