Abstract

Background: In infertile men with severe oligospermia (sperm concentration <5million/mL) undergoing ICSI the choice between using ejaculated sperm or testicular sperm remains controversial. Testicular sperm have shown lower levels of DNA damage compared with ejaculated spermatozoa from the same individuals.

Objective: To compare intracytoplasmic sperm injection (ICSI) outcome in patients with severe oligospermia using testicular versus ejaculated spermatozoa.

Design: Retrospective cohort study.

Setting: Medina Fertility Center

Materials and Methods: Patients with severe oligospermia who underwent ICSI cycles with either testicular or ejaculated sperm between January 2015 and December 2017 were included in this study. 205 couples met the study criteria after exclusion of cycles with mixed sperm sources. Patients were divided into 2 subgroups according to the source of sperm used in intracytoplasmic sperm injection (ICSI) cycle; (Group A) included 104 patients in which ejaculated sperm were injected while (Group B) included 101 patients where fresh testicular sperm were extracted (TESE) and injected. The medical records of the included couples were reviewed and tabulated regarding demographic data, reproductive history, hormonal profiles and different semen parameters. The reproductive outcomes; fertilization rate, number of high-quality embryos, and pregnancy rate were evaluated and compared in both groups.

Results: There was no significant difference in the fertilization rate between the two subgroups (group A 67.93%, group B 68.01%, p=0.960), the total number of high-quality embryos tended to be higher in the testicular sperm group, but the difference did not reach statistical significance (187 vs 154, P= 0.084). The clinical pregnancy rate was significantly higher in group B where testicular spermatozoa were injected (49.50% vs 35.57%, p=0.044*).

Conclusion: In patients with severe oligospermia, when both sources of spermatozoa are available (i.e. ejaculate or testicular) for the ICSI procedure, TESE should be considered as it offers higher pregnancy rates

Keywords: Infertility; Severe oligospermia; Intracytoplasmic sperm injection; Testicular sperm extraction (TESE)