Testicular sperm retrieval for intracytoplasmic sperm injection: when to consider it after unsuccessful intracytoplasmic sperm injection with ejaculated sperm?

Abstract

AbstractBackgroundThe question of whether patients are more likely to succeed with testicular sperm intracytoplasmic sperm injection (T‐ICSI) after unsuccessful ICSI with ejaculated sperm (Ej‐ICSI) remains unknown.ObjectiveThe study aimed to identify potential predictors of successful T‐ICSI in men with idiopathic infertility and oligozoospermia (sperm concentration < 15 × 106/mL, non‐azoospermic) who had previously experienced unsuccessful Ej‐ICSI.Materials and methodsIn total, 154 couples with male partners who had oligozoospermic conditions after two unsuccessful cycles of Ej‐ICSI switched to T‐ICSI. Before initiating T‐ICSI, the sperm DNA fragmentation index (DFI) was assessed in ejaculated specimens. Participants were divided into two groups: group A (live birth (+), n = 60) and group B (live birth (−), n = 94).ResultsFertilization, clinical pregnancy, live births, and miscarriages had rates of 72.7%, 44.2%, 39%, and 5.2%, respectively. The total motile sperm (TMS) count in group A was significantly higher (3.8 ± 1.5 million) than in group B (3 ± 1.6 million; p = 0.002). DFI was significantly higher in group A (24.2 ± 12.3) than in group B (18.1 ± 11; p = 0.001). Hormone levels and oocyte counts showed no statistically significant differences between groups. Multivariate regression analysis revealed that TMS (odds ratio [OR]: 1.46; 95% CI, 1.14–1.87, p = 0.003) and DFI (OR: 1.04; 95% CI, 1.01–1.08, p = 0.009) were found to be significant predictors of live birth outcomes. At a cutoff point of 2.55 (area under the curve [AUC] = 0.65), the optimal sensitivity and specificity values for TMS were 78% and 48%, respectively. At a cutoff point of 25.8 (AUC = 0.65), DFI had a maximum sensitivity of 51.7% and a specificity of 78.7%.ConclusionsTMS and DFI were found to be significant predictors of live birth outcomes in couples with oligozoospermic male partners undergoing T‐ICSI. These findings may help clinicians tailor treatment strategies for this specific patient population.