(095) THE USE OF EJACULATED VS TESTICULAR SPERM IN MEN WITH EITHER CRYPTOZOOSPERMIA OR NON-OBSTRUCTIVE AZOOSPERMIA

Abstract Introduction Although use of ejaculated sperm for Intracytoplasmic Sperm Injection (ICSI) in men with cryptozoopsermia obviates conventional testicular sperm extraction (cTESE) or micro testicular sperm extraction (mTESE), there exists an ongoing debate as to whether testicular sperm produce better ICSI outcomes. Objective To better understand this issue, we identified all men presenting to single reproductive urologist’s practice and a single IVF center with cryptozoopsermia (CZ) or non-obstructive azoospermia (NOA) and analyzed ICSI outcomes. Our study represents the largest single-surgeon analysis conducted in the US. Methods All men presenting to a single reproductive urologist’s practice with CZ or NOA and who subsequently underwent ICSI were identified during 2012 to 2023. Per our practice pattern, men with NOA first underwent Testicular Core Extraction (TCE); those with sperm underwent office cTESE and those without sperm underwent operative mTESE. Three groups undergoing ICSI cycles were then identified: Cryptozoospermic men in which ejaculated sperm was used (n = 30), cTESE in which extracted sperm were used after a positive TCE (n = 33), and mTESE in which operatively extracted sperm was used after a negative TCE (n = 7). Fertilization and embryo rates per number of eggs inseminated were compared between groups using GraphPad Prism Software. P < 0.05 deemed significance using One-way ANOVA. Results Fertilization rates were highest within the cTESE group (81%) v. the ejaculated group (74%) v. the mTESE group (40%) (p = 0.02). As expected, embryo rates were overall lower than fertilization rates; however, the same pattern emerged albeit non-significantly: cTESE 36%, ejaculated 31%, and mTESE 10% (p = 0.2). Following our practice pattern, men undergoing operative mTESE after negative TCE had significantly poorer ICSI outcomes (p = 0.0004). Conclusions Advances in ICSI technology have resulted in successful birth outcomes from the ejaculate of male partners with CZ. As such, many male partners go directly to IVF and never undergo appropriate workup and treatment by a reproductive urologist. Testicular sperm harbor less DNA damage, ejaculatory contaminate, and diminished exposure to reactive oxygen species. Per our data, the use of testicular sperm is associated with improved ICSI outcomes. Furthermore, we demonstrate that men requiring operative mTESE after negative TCE have a lesser chance of successful ICSI results. Disclosure No.