Sperm obtained via microsurgical testicular sperm extraction (mtese) results in a similar blastulation rate and ongoing pregnancy rate as sperm obtained via testicular sperm aspiration (tesa)

In patients with non-obstructive azoospermia (NOA), mTESE is the gold standard treatment option for those who hope to build their family without donor sperm. However, it is unknown if use of sperm obtained via mTESE negatively impacts outcomes. This study compares embryology and pregnancy outcomes in patients who underwent mTESE due to NOA with those who underwent TESA due to obstructive azoospermia (OA). This was a retrospective cohort study of patients who underwent mTESE for NOA or TESA for OA or ejaculatory dysfunction at a university-affiliated center between November 2017 and January 2023. In patients who had sperm retrieved, intracytoplasmic sperm injection (ICSI) was performed. All blastocysts created underwent preimplantation genetic testing for aneuploidy (PGT-A), followed by single euploid frozen embryo transfer (FET). Only the first IVF and FET cycles were included in the analyses. The primary outcome was blastulation rate, defined as the number of blastocysts over the number of fertilized zygotes. Secondary outcomes were sperm retrieval rate, fertilization rate, euploidy rate defined as number of euploid blastocysts over number of blastocysts biopsied, clinical pregnancy rate (CPR), pregnancy loss rate, and sustained implantation rate (SIR), defined as ongoing intrauterine pregnancy at 8 weeks gestation. Results were adjusted for oocyte age, embryo grade as determined by modified Gardner grading, and body mass index. Data analysis was performed using the two-tailed T test and logistic regression analysis. Patients who underwent mTESE (N=153) compared with TESA (N=174), had a lower sperm retrieval rate (58.8% vs 100%; p<0.01) and fertilization rate (44.5% vs 60.6%; p<0.01). However, in couples who made blastocysts, the mean blastulation rate (52.7% vs 52.4%; p=0.93), the mean number of useable blastocysts (4.4 vs 5.4; p=0.12), and the mean euploidy rate (59.9% vs 59.3%; p=0.91) were not significantly different between the two groups. Similarly, of those couples who produced at least one euploid blastocyst and underwent FET, there was no significant difference between the mTESE and TESA groups, respectively, in CPR (77.8% vs 74.8%, p=0.90), loss (9.3% vs 18.3%, p=0.14), or SIR (68.5% vs 67.8%, p=0.96). Patients with NOA who undergo successful sperm extraction with mTESE followed by IVF-ICSI have a similar blastulation and euploidy rates compared to those who utilize sperm obtained via TESA for OA, although fertilization rate is greater in the TESA group. If creation of euploid embryos is achieved, there is no difference in CPR, loss rate, or SIR between mTESE and TESA patients.