Improved in vitro fertilization embryo quality and pregnancy rates with intracytoplasmic sperm injection of sperm from fresh testicular biopsy samples vs. frozen biopsy samples

Objective To compare the outcomes of first-attempt IVF–intracytoplasmic sperm injection (ICSI) cycles when using fresh testicular biopsy samples vs. frozen biopsy samples. Design Retrospective chart review of 92 consecutive first-attempt IVF-ICSI cycles. Setting Two IVF programs. Patient(s) Forty consecutive first-attempt IVF-ICSI patients using sperm from fresh testicular biopsy samples and 52 consecutive first-attempt IVF-ICSI cycles using frozen testicular biopsy samples. Intervention(s) Testicular biopsy, IVF-ICSI with fresh and frozen-thawed spermatozoa. Main outcome measure(s) Fertilization rates, embryo quality, pregnancy, delivery, and spontaneous abortion rates. Result(s) A significantly increased ICSI fertilization percentage was obtained with frozen testicular biopsy samples (76.5 % ± 3.1 % ) vs. fresh biopsy samples (68.3 % ± 2.6 % ). However, embryo quality, pregnancy, and delivery rates were higher in the fresh biopsy group. Mean embryo score was 4.54 ± 0.31 and 3.62 ± 0.2 in the fresh vs. frozen group, respectively. Chemical pregnancy rates (60 % vs. 49.1 % ), clinical pregnancy rates (56.4 % vs. 41.2 % ), and delivery rates (48.7 % vs. 31.2 % ) were each higher in the fresh group vs. frozen group. Accordingly, the spontaneous abortion rate was lower in the fresh group (21.7 % ) vs. the frozen group (33.3 % ). Conclusion(s) Although the use of frozen biopsy samples has logistical advantages, we conclude it may be advantageous to use fresh testicular biopsy samples in IVF–ICSI cases whenever possible, as fresh specimens yielded significantly improved embryo quality, generally higher pregnancy rates, and lower spontaneous abortion rates.