Abstract
Objectives: This study compared outcomes between oligo-asthenoterathozospermia (OAT) patients who underwentmicrosurgical testicular sperm extraction (m-TESE) due to recurrent assisted reproduction (ART) failureand patients in whomm-TESE was canceled because motile spermatozoa were found in the ejaculate.
Methods: This retrospective study examined the outcomes of couples who underwent ICSI using either ejaculate or m-TESE due to OAT between November 2016 and January 2024. The study analyzed 172 couples: 66 in the ejaculate group (Group 1) and 106 in the m-TESE group (Group 2). All patients had fewer than 1 million spermatozoa, with or without less than 1% normal sperm morphology, and less than 5% progressive motility in subsequent two semen analyses.
Results: Of the 106 patients, 69.81% (n = 74) had a sperm retrieval rate (SRR). There was no significant difference between the groups in terms of female age (p = 0.590), male age (p = 0.782). On the 3rd day, the embryo transfer rate was significantly higherin the m-TESE group (32.2% vs. 8.3%, p = 0.003), whereas on the 5th day, the embryo transfer and FET cycle rates were higher in the ejaculate group (61.7% vs. 37.9%, p = 0.015). The overall pregnancy rate (59.1% vs. 33%, p = 0.001) and overall live birth rate (37.9% vs. 22.6%, p = 0.031) were significantly higher in the ejaculate group.
Conclusion: The reproductive success of ejaculate was higher than m-TESE. Recommending ICSI with ejaculate before m-TESE can be considered even in severe OAT patients who have recurrent ART/ICSI failure.