Re: Analysis of the Outcome of Intracytoplasmic Sperm Injection Using Fresh or Frozen Sperm

Abstract

Objectives: To compare the outcome of first-attempt intracytoplasmic sperm injection (ICSI) ICSI– embryo transfer (ET) cycles using frozen-thawed testicular sperm (FTTS), fresh testicular sperm (FTS), frozen-thawed epididymal sperm (FTES) and fresh epididymal sperm (FES) so as to determine which of these has the most successful ICSI outcome with respect to fertilization rate (FR), pregnancy rate (PR) and birth rate. To assess the outcomes according to the underlying aetiology of azoospermia. Patients and Methods: The records of 493 patients undergoing first-attempt ICSI between 1993 and 2008 were reviewed retrospectively. FTS was used in 112 cycles, FTTS in 43 cycles, FES in 279 cycles, and FTES in 59 cycles. Within each group, the aetiology of the azoospermia was recorded according to history, clinical examination and histological analysis (n 316). The FR, clinical PR and delivery rate were calculated for each group with respect to the type of sperm retrieval used. Results: Analysis of the data showed no significant differences between any of the four groups in the FR, PR or delivery rate (P 0.05). There were no significant differences seen between fresh sperm (FTS and FES) and frozen sperm (FTTS and FTES) or between epididymal sperm (FES and FTES) and testicular sperm (FTS and FTTS) in any of the outcomes measured (P 0.05). However, subset analysis showed a statistically higher FR and PR for FTTS over fresh sperm. When comparing aetiologies, there was no significant difference in the FR, clinical PR and delivery rate between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) groups. However, sub-set analysis showed a higher PR and birth rate for FTTS over fresh sperm in both OA and NOA groups. Conclusions: The results of the present study suggest that using frozen sperm in ICSI cycles is a reliable and favourable method with the same outcome as fresh sperm. Testicular and epididymal sperm have similar ICSI outcomes for both fresh and frozen samples. However, results suggest a tendency for higher PRs and birth rates for frozen than for fresh testicular sperm in both OA and NOA aetiologies. The aetiology of azoospermia does not significantly affect the outcome of first-attempt ICSI. The higher rates in the frozen groups suggest that these patients have had better quality semen when they were initially harvested and frozen.