Cumulative IVF outcomes following retrieval of testicular spermatozoa: should we use immotile sperm for ICSI?

Abstract Research question We aimed to compare cumulative clinical pregnancies (CPR) and live births rates (LBR) of ICSI cycles using testicular motile and immotile spermatozoa obtained from either testicular sperm aspiration (TESA) or extraction (TESE). Design A retrospective analysis of ICSI-TESA/TESE cycles during a 7-year period. Cycles were divided into two groups according to the motility of the retrieved spermatozoa: Group A consisted of couples with motile spermatozoa, and group B of couples with immotile sperm. Group B was further divided into 2 subgroups: Group B1 consisted of couples with motile sperm, and group B2 with immotile sperm following the addition of pentoxifiline (PF). Results Following the first fresh embryo transfer, there were no differences in LBR per transfer between the study groups. There was higher CPR in Group A vs. Group B1. When considering the following thawed embryo transfer cycles, none of the thawed cycle with embryos derived from the ICSI of immotile sperm following the addition of PF, resulted in pregnancy. The cumulative CPR [51.9% to 33.8% to 12.5% for group A, B1 and B2 respectively (p=0.001)] and LBR [40.7% to 24.7% to 12.5% for group A, B1 and B2, respectively (p=0.01)] per oocyte retrieval was significantly higher when using motile sperm compared to motile or immotile following the addition of PF.. Conclusions While fertilization, TQE, cumulative CPR, and LBR, decrease when using immotile sperm, ICSI is still valid, and therefore should be considered and offered to couples before embarking on donor sperm, or cryopreserving oocytes for future additional testicular sperm retrieval.