REEVALUATING AZOOSPERMIA: IDENTIFICATION OF CRYPTOZOOSPERMIA AND ITS IMPACT ON INFERTILITY TREATMENT WITH INTRACYTOPLASMIC SPERM INJECTION

Abstract

Objective

Cryptozoospermia is a challenging condition characterized by extremely low sperm counts in the ejaculate, only detectable after centrifugation and meticulous microscopic examination. Due to either incomplete evaluation or inadequacy of traditional semen analyses, most patients with cryptozoospermia are diagnosed as azoospermia in many centers, leading suboptimal treatment and incorrect therapeutic strategies. We aim to present the demographic, clinical and follow-up data of patients who were diagnosed with azoospermia in an external center and diagnosed with cryptozoospermia in our center.

Materials and Methods

We retrospectively analyzed the data of 515 patients who applied to our center due to infertility and underwent semen analysis between April 2021 and April 2024. The clinical and demographic data of the patients with cryptozoospermia were analyzed comparatively with the data of 239 non-obstructive azoospermia patients who underwent micro-TESE. The ICSI outcomes (fertilization and clinical pregnancy rates) were compared between the groups which underwent fresh ejaculated sperm and testicular sperm were used the same day of oocyte pick up.

Results

695 semen analyses of 515 patients were analyzed, and 372 of these patients had azoospermia. When the samples of these patients were re-examined after Percoll centrifugation, 93 samples were found to have motile sperm cells. Of these patients, 19 patients with previously diagnosed cryptozoospermia, hypogonadotropic hypogonadism, or severe oligoasthenoteratospermia were excluded, and 74 (19,9 %) patients who were previously diagnosed with azoospermia in another center and found to have cryptozoospermia were included in the final analysis.

Demographic and clinical data of these patients and comparative analysis of demographic and clinical characteristics of cryptozoospermia and non-obstructive azoospermia patients are given in Table 1. Comparison between fresh ejaculated sperm and testicular sperm usage for ICSI did not show difference between fertilization and pregnancy rates (Table 2).

Conclusion

In our study, we found that nearly 20% of men initially diagnosed with azoospermia actually had sperm present in their ejaculate with meticulous sperm detection. Patients with cryptozoospermia exhibited significantly higher levels of FSH, total testosterone and testicular volume compared to men with azoospermia. Additionally, we observed higher rates of parental consanguinity and AZFc microdeletion in Y chromosome in cryptozoospermia patients, indicating potential genetic factors contributing to this condition. Importantly, using ejaculated sperm for ICSI resulted in comparable fertilization and pregnancy rates to those achieved with surgically retrieved testicular sperm, suggesting that non-invasive sperm retrieval methods could be a viable option for many patients, potentially avoiding surgical procedures.