Testicular sperm retrieval and cryopreservation prior to initiating ovarian stimulation as the first line approach in patients with non-obstructive azoospermia

The potency for fertilization and successful implantation was compared betw een fresh and cryopreserved testicular spermatozoa obtained from the same p atient with nonobstructive azoospermia, Spermatozoa cryopreserved at the ou tset were also evaluated. Non-obstructive azoospermic men(n = 55) underwent testicular sperm extraction (TESE); mature spermatozoa were found in 33 (6 0%) of them. Of 57 intracytoplasmic sperm injection (ICSI) cycles in 25 pat ients, 15 used fresh spermatozoa (14 patients, group 1), 24 used the excess spermatozoa cryopreserved after 'fresh' ICSI (11 couples who did not conce ive in the 'fresh' cycle, group 2) and 18 cycles used cryopreserved spermat ozoa at the outset (11 other patients, group 3), Fertilization, cleavage, e mbryo quality, implantation and take home baby rates were not significantly different in groups 1 and 2, and 6/14 couples ultimately had healthy babie s (42.8% cumulative take home baby rate per TESE). In group 3, neither the fertilization rate, embryo development, pregnancy nor implantation rates pe r embryo transfer were significantly different from groups 1 and 2, The cum ulative delivery and ongoing pregnancy rate in this group was 36.4%. Cryopr eservation did not impair the availability of motile spermatozoa for ICSI, When immotile spermatozoa were injected, however, fertilization rate decrea sed dramatically. Since criteria for predicting the presence of spermatozoa in the testicular tissue of patients with non-obstructive azoospermia are inadequate, it is suggested that TESE be performed prior to initiating ovar ian stimulation.