Cumulative live birth rates following testicular sperm extraction in non-obstructive male infertility

This retrospective observational cohort study was designed to evaluate the cumulative live birth rates achieved through testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) in couples affected by isolated non-obstructive male infertility, to better estimate their chances of achieving biological fatherhood. We also aimed to estimate their time to live birth, and identify predictive factors of successful TESE. We included all couples undergoing a first TESE procedure for isolated non-obstructive male infertility at a tertiary university hospital between January 2014 and December 2024. Our main outcomes were : Sperm retrieval rate, live birth rate per ICSI cycle, cumulative live birth rate, and time to live birth. Among 168 included couples, sperm retrieval was successful for 99 patients (58.9 %). Forty men (23.8 % of the couples included) achieved biological fatherhood. The mean live birth rate per ICSI cycle was 32.8 %, with a cumulative live birth rate of 45 % after four ICSI cycles. Median time to live birth was 19.5 months from the first TESE and 10 months from the first ICSI attempt. Thirty-eight men achieved fatherhood through sperm donation (22.6 % of the cohort). Median time to live birth was 3 years from the first consultation, irrespective of TESE or sperm donation. TESE-ICSI provides a substantial probability of achieving biological fatherhood in couples with non-obstructive male infertility, with clinically relevant cumulative live birth rates and time to live birth, supporting informed counseling and decision-making.