Micro-Surgical Sperm Retrieval Surgery and IVF/ICSI in Azoospermic Couples: A "fresh" or "Frozen" Procedure?

Introduction

Sperm availability for fertility treatments is limited in azoospermic men. Therefore, optimization of IVF/ICSI is crucial. Sperm/ova retrieval coordination yields "fresh" (non-cryopreserved) sperm/ova, but it`s logistically challenging, especially in a public setting.

Aim

To compare the impact of sperm and/or cryopreservation on IVF/ICSI outcomes in azoospermic couples.

Methods & Materials

A retrospective analysis of a prospectively-built institutional data-base, including azoospermic couples who had micro-surgical sperm retrieval surgery (mSRS) in 2013-2017, in a public medical facility setting. mSRS type, sperm retrieval rate (SRR) and pregnancy outcomes were analyzed. Further stratification into 3 groups, to control for cryopreservation effect: 1-"fresh" sperm/"fresh" ova, 2-"frozen" sperm/"fresh" ova, 3-"fresh sperm"/"frozen" ova.

Results

Seventy-two azoospermic couples underwent 75 mSRS (including 12 "viral SRS/IVF") and comprised our study-population. mSRS type matched the azoospermia type: micro-surgical testicular sperm extraction (mTESE) for non-obstructive azoospermia in 64 (85.4%), micro-surgical epididymal sperm aspiration (MESA) for obstructive azoospermia in 11 (14.6%). The sperm retrieval rate (SRR) was 100% (11/11) in MESA, 34.3% (22/64) in mTESE. In naïve couples (no prior SRS), SRR in mTESE was even higher: 40.8% (20/49). Pregnancy outcomes by group: 1-pregnancy rate (PR) and clinical pregnancy rate (CPR) were both 50%, 2-PR/CPR dropped to 29% and 21% and in 3- PR/CPR was only 19% and 13%, respectively.

Conclusions

Our data strongly support use of "fresh" sperm/ova in azoospermic couples who undergo mSRS. It is our institutional decision to aspire to closely coordinate sperm/ova retrieval and share the suggested limitations of cryopreservation with couples, undergoing these challenging IVF/ICSI procedures.