Background: Testicular sperm extraction followed by Intracytoplasmic Sperm Injection (TESE-ICSI) is the only route to genetically father a child in couples with Non-Obstructive Azoospermia (NOA).
Objective: The aim was to identify the effect of severity of NOA on clinical pregnancy following ICSI.
Patients and Methods: This retrospective study included 643 patients who underwent 712 ICSI cycles at a specialized In-Vitro Fertilization center between 2014 and 2019. We classified the patients into easy (445) and difficult NOA (267) based on the difficulty of microdissection TESE procedure, number of sperm retrieved, and the number of surgical attempts.
Results: The clinical pregnancy rate is significantly higher in the easy NOA group [167/299 (55.8%)] as compared with the difficult NOA group [68/194 (35.1%)]. The mean age of the females and the mean follicle stimulating hormone (FSH) levels were significantly lower in the easy NOA group compared with the difficult group [27.5±4.3 vs 29.9±4.6 years, P=0.0001, and 6.8±2.1 vs 7.4±2.5 mIU/ml, P=0.004, respectively]. There were no significant differences between the 2 groups regarding the mean male age, FSH level, and testicular size. The cumulus mass and the number of mature oocytes injected correlated significantly with the clinical pregnancy (r=0.122, P=0.012 and r=0.145, P=0.003, respectively). The sperm source whether fresh or frozen, the testicular pathology, and the identification of round spermatids in the pathology specimens did not correlate with the clinical pregnancy. We used the binary logistic regression to identify the final predictors. Only the NOA severity could be used to predict ICSI outcome. Easy NOA is more likely to have positive outcomes with ICSI (Odds ratio=1.70; Confidence interval=1.069–2.71; P=0.025). The model showed that neither female age nor FSH level could predict ICSI outcome in those patients.
Conclusion: Easy sperm retrieval is an independent factor that is associated with positive ICSI outcomes in couples with NOA.