Comparison of Pregnancy Rate and Live Birth Rate of Intracytoplasmic Sperm Injection Cycles Using Fresh Versus Frozen-Thawed Testicular Sperm.

Objectives: The primary objective of the study is to compare the rate of pregnancy and live birth rate in infertile couples with nonobstructive azoospermia (NOA) treated with either fresh or frozen sperms in intracytoplasmic sperm injection (ICSI) cycles. It is already known that the use of frozen sperm in ICSI cycles is considered favorable and is reported to have no significant difference in outcomes when compared to fresh sperm. However, there is still an ongoing debate about the superiority of fresh or frozen-thawed spermatozoa in men with NOA, particularly in the context of Saudi Arabia where this subject has not been previously investigated. Design: This retrospective cohort study was conducted at the in vitro fertilization (IVF) unit at KAMC-R, Ministry of National Guard Hospital Affairs (MNGHA) in Riyadh, Saudi Arabia. It includes couples who underwent ICSI cycles throughout four years (2019-2022), provided that they had no female infertility causes. A checklist was prepared to collect data from patients' medical records. Participants Setting and Methods: This retrospective cohort study analyzed data from 230 infertile couples who underwent ICSI cycles between 2019 and 2022. We compared pregnancy, live birth, and overall success rates in cycles using fresh versus frozen-thawed testicular sperm, controlling for factors like age, infertility type, and hormone levels. Statistical analysis included chi-square tests, Fisher's exact tests, Student's t tests, and Mann-Whitney tests to compare outcomes between groups. Results: A total of 231 women were included. Their mean ± standard deviation (SD) age was 31.5 ± 5.4. Almost two-thirds (67.5%) had primary infertility. Regarding the type of sperms used in intracytoplasmic sperm injection, fresh sperms represented 57.1%, while the remaining 42.9% were frozen sperms. Rates of pregnancy, live births, ectopic pregnancy, and abortion were 32.5%, 23.5%, 3.5%, and 5.7%, respectively. Overall, the success rate of ICSI was 29.8%. The pregnancy rate was significantly higher using fresh spermatozoa in ICSI than frozen spermatozoa (37.9% vs. 25.3%), p=0.043. Similarly, live births and overall successful outcome rates of using fresh spermatozoa in ICSI were significantly higher than those of frozen spermatozoa (28.8% and 34.8% vs. 16% and 22.6%), p=0.025 and 0.048, respectively. Limitations: The study demonstrated an association between fresh sperm use and higher success rates, but it did not prove causality. Conclusion: When both fresh and frozen sperm were used, the rates of pregnancy, live birth, and overall success in ICSI were higher in fresh sperm. Additionally, younger males and females showed a greater likelihood of successful ICSI outcomes. There is a potential benefit of using fresh sperm in ICSI for this specific patient group but highlights the need for further investigation to solidify these findings and to explore the reasons behind the observed differences. This study adds to the growing body of knowledge on ICSI for men with NOA and emphasizes the need for further research to refine clinical practice and improve outcomes for couples facing infertility.