Comparison of fertilization and pregnancy rates between azoospermia patients whose sperm were obtained by TESE and cryptozoosperm in ICSI cycles

Infertility is the inability of couples to achieve pregnancy despite unprotected sexual intercourse for at least one year. The male factor is present in almost half of the couples who cannot achieve pregnancy. The use of assisted reproductive techniques in men with extremely low sperm count and sperm motility, such as cryptozoospermia or azoospermia, requires ICSI. The aim of this study was to retrospectively compare fertilization and pregnancy rates for patients who underwent Testicular Sperm Extraction (TESE) due to azoospermia and those with cryptozoospermia who underwent intracytoplasmic sperm injection (ICSI). 528 patients (256 with azoospermia and 272 with cryptozoospermia) who met the study criteria were included in the study. Azoospermia was present in 48.5% (n=256) of the patients in the first group, while cryptozoospermia was present in 51.5% (n=272) of the patients in the second group. Fertilization was observed in 100% of the cases (n=528). Embryo transfer could not be performed in 92 of the 528 cases due to various reasons, while embryo transfer was performed in 436 cases. Pregnancy was observed in 55.7% (n=243) of the cases with embryo transfer, while it was not observed in 44.3% (n=193). The freezing rate was significantly higher in the cryptozoospermia group than in the azoospermia group (p=0.006; p<0/01). The rate of cases with 2PN count ≥6 in the cryptozoospermia group was significantly higher than that in the azoospermia group (p=0.036; p<0/05). The pregnancy rate was 51% in the azoospermic group and 49% in the cryptozoospermic group (p<0.059), and there was no significant difference between the two groups. In conclusion, there was no difference in pregnancy rates, but it was observed that the number of embryos to be frozen after fertilization and embryo transfer was higher in cryptozoospermia group. Based on this evaluation, it was concluded that applying TESE in cryptozoospermia cases instead of ejaculate sperm would increase fertilization and the number of frozen embryos, but it would not increase the transfer and pregnancy rates.