Retrospective study evaluates fertilization and live birth rates in azoospermia with varying sperm yield and freezing methods, suggesting implications for treatment.
Background Microdissection testicular sperm extraction is the preferred method for sperm retrieval in men with non‐obstructive azoospermia. However, the effects of sperm retrieval quantity and freezing on intracytoplasmic sperm injection outcomes remain incompletely understood. Objectives To evaluate the impact of sperm quantity and freezing status on fertilization and cumulative live birth rate following intracytoplasmic sperm injection using microdissection testicular sperm extraction spermatozoa in non‐obstructive azoospermia patients. Materials and Methods We retrospectively analyzed 1394 microdissection testicular sperm extraction–intracytoplasmic sperm injection cycles performed between 2017 and 2022 at a single tertiary center. Sperm retrieval yield was stratified into three groups: sufficient sperm count (> 10 spermatozoa/100 fields), low sperm count (6–10/100), and extremely low sperm count (1–5/100). Fertilization rate (two pronuclei) and cumulative live birth rate were compared across sperm retrieval yield and freezing subgroups. Multivariable regression and interaction models assessed the independent and combined effects of sperm quantity and freezing status. Results Fertilization and cumulative live birth rate declined significantly with reduced sperm counts (two pronuclei: 53.6%→32.2%; cumulative live birth rate: 49.8%→21.8%; p < 0.001). Frozen spermatozoa yielded comparable outcomes to fresh spermatozoa overall, but in the extremely low sperm count group, frozen spermatozoa were associated with a significantly lower cumulative live birth rate than fresh spermatozoa (12.3% vs. 29.3%; p = 0.015). Interaction analysis confirmed this adverse effect (OR = 0.39; 95% CI 0.16–0.95; p = 0.038). No significant freezing effect was observed in the other groups. Conclusion Sperm retrieval quantity is an important predictor of intracytoplasmic sperm injection success in men with non‐obstructive azoospermia. Freezing generally does not affect outcomes, but may significantly reduce live birth rates when sperm availability is extremely limited. Prioritizing the use of fresh spermatozoa in such cases may improve clinical outcomes.
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Lei et al. (2026) studied this question.
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