Clinical outcomes of in vitro fertilization using testicular sperm versus urinary-recovered sperm in men with complete retrograde ejaculation: A single-center, retrospective, comparative study

Complete retrograde ejaculation (CRE) can cause infertility in males. In vitro fertilization (IVF) is an important treatment approach. Several guidelines and expert consensus documents have proposed the use of testicular sperm (TS) or urinary-recovered sperm (URS). However, studies comparing the efficacy of TS and URS in IVF cycles remain scarce. This study primarily compared the clinical outcomes between TS and URS in IVF cycles. This retrospective analysis examined 23 CRE patients treated at the Reproductive Medicine Center of Yichang Central People's Hospital from December 2015 to December 2024. Patients were divided into two groups: TS (n = 14) and URS (n = 9). IVF parameters recorded included the double-pronuclear fertilization rate, high-quality embryo (HQE) rate, usable embryo rate, clinical pregnancy rate, live birth rate, and miscarriage rate. When compared between groups, the TS group demonstrated significantly higher rates of the following: double-pronuclear fertilization (86.11% vs 72.84%, P = .022), HQE rate (29.03% vs 13.79%, P = .043), clinical pregnancy rate (60.87% vs 27.78%, P = .048), and live birth rate (52.17% vs 16.67%, P = .017). This study suggests that TS is superior to URS for IVF in CRE patients. The advantages of TS primarily lie in achieving normal fertilization and generating HQEs. However, this study has limitations, such as its small sample size and single-center, retrospective design.