Semen Quality and DNA Fragmentation After Limited Testicular Sperm Extraction in Non‐Azoospermic Men With ART Failure: A Retrospective Matched Cohort Study

ABSTRACT Background and Aims Testicular sperm extraction (TESE) is sometimes used in non‐azoospermic men with persistent infertility, particularly in cases of high sperm DNA fragmentation index (DFI) or repeated intracytoplasmic sperm injection (ICSI) failure. However, the impact of TESE on subsequent semen quality and sperm DNA integrity remains unclear. This study aimed to evaluate the effects of limited TESE on semen parameters and DFI in non‐azoospermic men. Methods In this retrospective matched cohort study, 160 non‐azoospermic men with at least three failed ICSI cycles were included between 2021 and 2024. Eighty patients who underwent limited TESE were compared with 80 age‐ and BMI‐matched controls. Semen parameters and DFI were assessed at baseline and after 3–6 months. Data distribution was evaluated using the Shapiro–Wilk test. Continuous variables were reported as mean ± standard deviation or median (interquartile range), as appropriate. Between‐group comparisons were performed using independent‐samples t ‐tests or Mann–Whitney U tests. Changes (Δ) were compared using ANCOVA adjusted for baseline values. A two‐sided p < 0.05 was considered statistically significant. Results No significant between‐group differences were observed in changes in sperm count (TESE: +8.6 ± 67.3 × 10 6 vs. control: +1.1 ± 53.3 × 10 6 , p = 0.45), morphology (TESE: +0.01% ± 0.61% vs. control: +0.01% ± 0.46%, p = 0.78), progressive motility (TESE: +0.86% ± 8.18% vs. control: +1.36% ± 7.02%, p = 0.92), or DFI (TESE: −1.55% ± 10.60% vs. control: −0.08% ± 8.92%, p = 0.29). Effect sizes were small and not clinically meaningful. Conclusion Limited TESE does not appear to adversely affect semen parameters or sperm DNA integrity over a short‐term follow‐up in non‐azoospermic men. These findings should be interpreted with caution, and further well‐designed prospective studies are required to confirm long‐term safety and reproductive outcomes.