Embryological outcomes of using surgical sperm in obstructive and nonobstructive azoospermia compared with ejaculated...

To compare embryology and pregnancy outcomes of sperm obtained via microdissection testicular sperm extraction (mTESE) and testicular sperm aspiration (TESA) with those from autologous ejaculated sperm and donor sperm.

Retrospective cohort study.

A total of 211 patients undergoing mTESE for nonobstructive azoospermia, 156 patients undergoing TESA for obstructive azoospermia, 9,074 infertile patients using autologous ejaculated sperm, and 536 patients using donor sperm at a university-affiliated private practice between January 2017 and December 2023.

mTESE or TESA.

The primary outcomes were fertilization rate, defined as the number of fertilized zygotes over the number of mature oocytes, and blastulation rate, defined as the number of blastocysts over the number of fertilized zygotes. Secondary outcomes were sperm retrieval rate, clinical pregnancy rate, pregnancy loss rate, preterm birth rate, infant birthweight and live birth rate (LBR).

A total of 211 (2.1%) patients underwent mTESE, 156 (1.6%) patients underwent TESA, 9,074 (90.9%) patients utilized autologous ejaculated sperm, and 536 (5.4%) patients utilized donor sperm. Sperm was retrieved in 98/209 (46.9%) of mTESE cases. The mTESE and TESA groups both had significantly lower mean fertilization rates (59.7% and 76.9%, respectively) compared with the autologous ejaculated sperm group and donor sperm group (84.2% and 85.1%, respectively). The mTESE group had a significantly lower fertilization rate compared with the TESA group. The blastulation rate was significantly lower in the mTESE group (49.8%) compared with the autologous ejaculated sperm group (57.8%) and the donor sperm group (59.2%). Still, it was not significantly different from the blastulation rate in the TESA sperm group (52.9%). The TESA sperm group had a significantly higher clinical pregnancy rate (79.4%) compared with the autologous ejaculated sperm group (67.6%) and the donor sperm group (65.5%), but it was not significantly different from the mTESE group (75.0%). There was a higher LBR in the TESA group (69.1%) compared with that in the autologous ejaculated sperm group (55.7%) and donor sperm group (55.3%). The TESA group LBR was not significantly greater than the mTESE group LBR (55.0%). There were no differences in rates of pregnancy loss, preterm birth, or infant birthweight between the four groups.

In mTESE patients who obtained sperm, fertilization and blastulation rates are marginally lower than those seen with autologous ejaculated sperm or donor sperm. Patients using sperm obtained via mTESE have lower fertilization rates than those using sperm obtained via TESA, but blastulation rates are not significantly different. Pregnancy outcomes after euploid frozen embryo transfer are equivalent in patients using sperm obtained via mTESE or TESA compared with autologous ejaculated sperm or donor sperm.