Translational andrology and urology · 2026
Retrospective cohort study of intracytoplasmic sperm injection outcomes using testicular vs. ejaculated sperm among patients with non-obstructive azoospermia or cryptozoospermia.
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Durbin Claudia G, Weidenbaum Emily, Alcide Phenix, Rothschild Chaya, Werner Michael, Blakemore Jennifer K, McCaffrey Caroline, Najari Bobby B
Аннотация
BACKGROUND: Non-obstructive azoospermia (NOA) represents the most severe form of male infertility, for which microsurgical testicular sperm extraction (mTESE) is the standard treatment. Extended sperm search and micro-freeze (ESSM) offers a non-invasive alternative for identifying rare spermatozoa in ejaculate, but its clinical utility as an initial intervention prior to mTESE remains uncertain. This study compares sperm identification rates and intracytoplasmic sperm injection (ICSI) outcomes among men with NOA or cryptozoospermia who underwent ESSM as an initial intervention vs. those who proceeded directly to mTESE.
METHODS: A retrospective cohort study of 73 male patients with NOA or cryptozoospermia severe enough to qualify for mTESE at NYU Langone Fertility Center between 2018 and 2024. Patients were categorized based on their initial intervention: ESSM-first group (n=45), in which ESSM was attempted prior to surgical retrieval, and an mTESE-first group (n=28), in which patients proceeded directly to surgery. The primary outcome was overall sperm identification rate per patient. Secondary outcomes included sperm retrieval success from mTESE after failed ESSM, and among patient proceeding to in vitro fertilization (IVF) with ICSI, fertilization rate, blastocyst formation rate, euploid rate, and live birth rate.
RESULTS: The stepwise ESSM-first strategy was associated with a higher overall sperm identification rate compared with proceeding directly to mTESE (76% vs. 54%, P=0.05, borderline statistical significance), driven primarily by the cryptozoospermia subgroup, in which 100% of patients identified spermatozoa via ESSM and avoided surgery. Among patients who failed ESSM, subsequent mTESE yielded sperm retrieval rates comparable to mTESE performed as the initial intervention (42% vs. 54%, P=0.49). Among IVF cycles with ICSI, fertilization rates with ejaculated vs. testicular sperm were similar (0.42 vs. 0.48, P=0.15). Blastocyst formation rates were higher with ejaculated sperm (0.50 vs. 0.20, P=0.002), while testicular sperm exhibited a non-significant trend toward higher euploid rates (0.68 vs. 0.40, P=0.07). There were no significant differences in live birth rates per embryo transfer cycle ejaculated vs. testicular sperm cycles (54% vs. 46%, P=0.66).
CONCLUSIONS: In men with NOA or cryptozoospermia eligible for surgical sperm retrieval, an ESSM-first strategy was associated with higher overall sperm identification rates while preserving comparable reproductive outcomes among those proceeding to IVF with ICSI. These findings support consideration of ESSM as an initial, non-invasive strategy prior to mTESE in appropriately selected patients.
METHODS: A retrospective cohort study of 73 male patients with NOA or cryptozoospermia severe enough to qualify for mTESE at NYU Langone Fertility Center between 2018 and 2024. Patients were categorized based on their initial intervention: ESSM-first group (n=45), in which ESSM was attempted prior to surgical retrieval, and an mTESE-first group (n=28), in which patients proceeded directly to surgery. The primary outcome was overall sperm identification rate per patient. Secondary outcomes included sperm retrieval success from mTESE after failed ESSM, and among patient proceeding to in vitro fertilization (IVF) with ICSI, fertilization rate, blastocyst formation rate, euploid rate, and live birth rate.
RESULTS: The stepwise ESSM-first strategy was associated with a higher overall sperm identification rate compared with proceeding directly to mTESE (76% vs. 54%, P=0.05, borderline statistical significance), driven primarily by the cryptozoospermia subgroup, in which 100% of patients identified spermatozoa via ESSM and avoided surgery. Among patients who failed ESSM, subsequent mTESE yielded sperm retrieval rates comparable to mTESE performed as the initial intervention (42% vs. 54%, P=0.49). Among IVF cycles with ICSI, fertilization rates with ejaculated vs. testicular sperm were similar (0.42 vs. 0.48, P=0.15). Blastocyst formation rates were higher with ejaculated sperm (0.50 vs. 0.20, P=0.002), while testicular sperm exhibited a non-significant trend toward higher euploid rates (0.68 vs. 0.40, P=0.07). There were no significant differences in live birth rates per embryo transfer cycle ejaculated vs. testicular sperm cycles (54% vs. 46%, P=0.66).
CONCLUSIONS: In men with NOA or cryptozoospermia eligible for surgical sperm retrieval, an ESSM-first strategy was associated with higher overall sperm identification rates while preserving comparable reproductive outcomes among those proceeding to IVF with ICSI. These findings support consideration of ESSM as an initial, non-invasive strategy prior to mTESE in appropriately selected patients.