Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction a meta analysis

Capsule:
After review and meta-analysis of the use of fresh versus cryopreserved sperm for intracytoplasmic sperm injection in azoospermic men with spermatogenic dysfunction, we found no difference in pregnancy or fertilization rates.

Authors:
Samuel Ohlander, M.D., James Hotaling, M.D., M.S., Eric Kirshenbaum, M.D., Craig Niederberger, M.D., F.A.C.S., Michael L. Eisenberg, M.D.

Volume 101, Issue 2, Pages 344-349, February 2014

Abstract:

Objective:
To determine if clinical pregnancy rates and fertilization rates with the use of cryopreserved sperm for intracytoplasmic sperm injection (ICSI) in patients with azoospermia due to spermatogenic dysfunction (i.e., nonobstructive azoospermia) are similar to those with fresh sperm.

Design:
Systematic review and meta-analysis.

Setting:
Academic medical center.

Patient(s):
Azoospermic men secondary to spermatogenic dysfunction.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Clinical pregnancy rate, fertilization rate.

Result(s):
Eleven studies met criteria for the outcome of clinical pregnancy rate. Seventy-nine (28.7%) of 275 intracytoplasmic sperm injection cycles using fresh testicular sperm resulted in a clinical pregnancy, compared with 84 (28.1%) of 299 intracytoplasmic sperm injection cycles using cryopreserved sperm (relative risk [RR] 1.00, 95% confidence interval [CI] 0.75–1.33). Ten studies met criteria for the outcome of fertilization rate. A total of 1,422 (52.9%) of 2,687 oocytes injected with fresh testicular sperm were fertilized, compared with 1,490 (54.0%) of 2,757 oocytes injected with cryopreserved sperm (RR 0.97, 95% CI 0.92–1.02).

Conclusion(s):
In men with azoospermia due to spermatogenic dysfunction, there is no statistical difference between the use of fresh versus cryopreserved-thawed testicular sperm when assessing clinical pregnancy or fertilization rates in couples undergoing ICSI.

  • Jason Kovac

    Study published this week in Urology Annals (Jan/Mar 2014, 6(1) 41-45) also shows no difference in fresh vs. frozen thawed spermatozoa for obstructive azoospermia as well.

  • This is an excellent review despite the heterogeneity of the studies included in this study This has long been a point of controversy between the Male Infertility Urologist and the REI. This meta-analysis demonstrates that outcomes between fresh vs. frozen are similar. This gives us additional support for a staged approach to men with non obstructive azoospermia instead of trying to kill ourselves in attempting to coordinate a fresh cycle with the female.

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