Abstract
In vitro fertilization (IVF) used in combination with intracytoplasmic sperm injection (ICSI) is indicated in couples with male factor infertility. Testicular sperm extraction (TESE) may improve success rates of ICSI by isolating sperm that have been shielded from oxidative damage. To date, few studies have identified semen parameters that predict success for IVF/ICSI using TESE sperm, and the effect of total motile sperm count (TMSC) has not been described. We sought to determine the effect of TMSC on ICSI outcomes in couples with isolated male factor infertility that underwent TESE. Data was collected prospectively from couples undergoing ICSI for isolated non-azoospermic male factor infertility using TESE sperm retrieved from 1/2016-1/2019. Couples were compared according to TMSC ≤ or >10 million per ejaculate. Biochemical pregnancy rates were compared in the two groups using linear logistic regression, controlling for female partner age and BMI. Twenty three couples underwent ICSI using TESE sperm. Median male partner age was 36.9 years (IQR:31.1-51.6) and median TMSC per ejaculate was 3.9 million (IQR:1.0-12.1). Female partner median age was 32.0 years (IQR:29.1-34.9) and median BMI was 27 (IQRL24-37). Six of seven (85.7%) couples in which the male partner had TMSC > 10 million achieved pregnancy, versus 4/16 (25%) with TMSC ≤ 10 million (p=0.007). TMSC >10 million was predictive of biochemical pregnancy (OR 17.0, CI 1.48-196, p=0.023). TMSC ≤10 million per ejaculate is predictive of ICSI failure in couples with isolated non-azoospermic male infertility.
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