Does Use of Testicular Sperm Improve Outcomes in Nonazoospermic Couples With Previous IVF Failure Using Ejaculated Sperm? [OP02-2B

Abstract

INTRODUCTION: Due to controversial evidence that testicular sperm is associated with lower sperm DNA fragmentation (SDF) and improved outcomes compared to ejaculated sperm (ES), this study evaluates intracytoplasmic sperm injection (ICSI) outcomes using testicular sperm in nonazoospermic couples with prior IVF failure using ES. METHODS: From Jan 2015-Aug 2018, nonazoospermic couples with ≥1 prior failed ART cycles using ES underwent testicular sperm extraction (TESE) for IVF/ICSI. Outcomes using TESE sperm were compared to the mean values of couples’ prior cycles using ES. Primary outcomes: clinical pregnancy and live birth rates (CPR & LBR). Secondary outcomes: fertilization and blastocyst conversion. RESULTS: 64 couples were evaluated with an average of 2.5 prior failed ART cycles using ES. There were 76 total transfers including fresh/frozen transfers and supernumerary embryo transfers. Compared to prior failed cycles with ES, TESE sperm resulted equivalent fertilization rates (61.4% vs. 59.0%, p=0.66), but significantly improved blastocyst conversion rates (61.9% vs. 42.9%, p<0.001) and blastocysts available for vitrification (1.6 vs. 0.6, p<0.003). CPR and LBR were improved (42.1% and 35.5%, respectively), but not statistically compared to the prior failed cycles due to regression of the mean. A comparison of TESE-ICSI cycles in couples with ≥2 prior failed ART cycles using ES did not change the findings. CONCLUSION: In nonazoospermic couples with failed ART using ES, ICSI using TESE sperm may improve blastocyst development, number of embryos available for vitrification, CPRs, and LBRs. Testicular sperm may bypass adverse effects of elevated SDF from ES and improve pregnancy outcomes.