Clinical implications of intracytoplasmic sperm injection using cryopreserved testicular spermatozoa from men with azoospermia

OBJECTIVE: To investigate whether sperm obtained by testicular sperm extrac tion (TESE) and cryopreserved well before intracytoplasmic sperm injection (ICSI) can serve as an effective sperm source. STUDY DESIGN: The role of cryopreserved testicular spermatozoa was evaluate d in a retrospective analysis of consecutive ICSI cycles using fresh or cry opreserved sperm; they were followed by prospective, planned treatment usin g cryopreserved sperm with a modified ICSI procedure. Sixteen men (22 cycle s) with obstructive or nonobstructive azoospermia were included in the retr ospective analysis. Another 25 men (29 cycles) were in the planned treatmen t group. Following these series, the pregnancy outcomes were compared betwe en ICSI cycles with fresh or cryopreserved testicular sperm. RESULTS: In the retrospective phase, 14 ICSI cycles were performed using fr esh sperm, with 8 using cryopreserved sperm. There were no statistically si gnificant differences between the two groups in any outcome measure. Planne d treatment with cryopreserved sperm resulted in a fertilization rate of 84 % and an embryo transfer rate of 89%. Thirteen couples (44%) achieved pregn ancy (five ongoing, six delivered). These rates were similar to those in th e retrospective phase of the study. All couples in the planned cryopreserva tion group had multiple aliquots (6.5 +/- 2.1) of sperm remaining after the first cycle. CONCLUSION: Cryopreserved sperm obtained by TESE can be used as an effectiv e sperm source in ICSI cycles. Planned cryopreservation allows multiple ali quots to be stored for use in subsequent cycles and thus avoids the need fo r repeat biopsies.