Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection

Objective: To determine the feasibility of using frozen-thawed testicular spermatozoa for intracytoplasmic sperm injection. Design: Prospective clinical study. Setting: A university hospital. Patient(s): One hundred seventy-five azoospermic men participating in a routine intracytoplasmic sperm injection program. Intervention(s): The men underwent testicular biopsy for cryopreservation of tissue to be used in consecutive intracytoplasmic sperm injection treatment cycles. Their female partners underwent controlled ovarian hyperstimulation for conventional IVF treatment. Main Outcome Measure(s): Fertilization and pregnancy rates. Result(s): In 77% of the patients, spermatozoa could be harvested from the testis by an open testicular biopsy technique and used for intracytoplasmic sperm injection after freezing and thawing of testicular tissue. Histopathologic evaluation revealed a Sertoli cell–only pattern in 21%, maturation arrest in 60%, and hypospermatogenesis in 19% of the patients. In 2.9% of the patients, carcinoma in situ or a germ cell tumor was detected. In all patients, viable spermatozoa could be visualized after the tissue samples were thawed. One hundred thirty-five intracytoplasmic sperm injection treatment cycles were performed, with a fertilization rate of 45% and a clinical pregnancy rate of 30% per oocyte retrieved. Conclusion(s): The use of frozen-thawed testicular tissue allows ovarian stimulation of the female partner to be timed and avoids cancellation of ovum pick-up when spermatozoa cannot be retrieved.