The impact of fresh versus cryopreserved testicular sperm on in-vitro fertilization outcomes in couples with elevated sperm DNA fragmentation: a retrospective cohort study

BACKGROUND: Elevated sperm DNA fragmentation (SDF) is associated with male factor infertility, recurrent pregnancy loss, and poor reproductive outcomes. An option for management includes the utilization of testicular sperm; however, the comparative reproductive efficacy of fresh versus cryopreserved testicular sperm men with elevated SDF remains unclear. Therefore, the objective of this study was to identify differences in reproductive outcomes between fresh and cryopreserved testicular sperm in patients with elevated SDF who are undergoing intracytoplasmic sperm injection (ICSI) after testicular sperm extraction (TESE). METHODS: This was a retrospective cohort study of a multi-site fertility network of patients with elevated SDF who underwent TESE and subsequent ICSI using either fresh or cryopreserved testicular sperm. RESULTS: A total of 60 men with elevated SDF underwent TESE and subsequent IVF with ICSI. 66.7% (n = 40) used fresh testicular sperm while the remaining 33.3% (n = 20) used cryopreserved testicular sperm following TESE. There were no significant differences in patient demographics or SDF (median 46.5 (IQR: 34.0, 59.0) vs. 48.0 (IQR: 38.0, 64.0), p = 0.525) between those that used fresh or cryopreserved testicular sperm. Among all initiated treatment cycles, there was no statistically significant difference in cumulative live birth (42.5% vs. 25.0%, p = 0.656), clinical pregnancy (55.0% vs. 35.0% p = 0.144) or miscarriage rates (10% vs. 5.0%, p = 0.185) between fresh and cryopreserved testicular sperm. Similarly, there were no significant differences in fertilization (median 48.8 (IQR 33.5, 61.3) vs. 43.7 (IQR:32.8, 63.1), p = 0.937) or blastocyst conversion (median 16.7 (IQR: 0.0, 40.0) vs. 26.1 (IQR: 16.7, 52.8), p = 0.106). CONCLUSION: Live birth, clinical pregnancy, miscarriage, fertilization and blastocyst yield were not significantly different when using fresh or cryopreserved testicular sperm in couples undergoing TESE for elevated SDF. Although this is the largest study examining these clinical outcomes to date, our study may have low statistical power and additional prospective studies with larger sample sizes are needed.