Fresh versus frozen-thawed testicular sperm for intracytoplasmic sperm injection in men with non-obstructive azoospermia: a systematic review and meta-analysis.
Samet Senel, Antonios Koudonas, Abdullah Said Sezgin, Abdullah Al-Mitwalli, Philippa Sangster, Mert Emre Erden, İlker Teke, Burcin Karamustafaoglu Balci, Murat Dursun
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引用次数: 0
Abstract
Introduction: The optimal use of fresh versus frozen-thawed testicular sperm for intracytoplasmic sperm injection (ICSI) in men with non-obstructive azoospermia (NOA) remains controversial. Although cryopreservation facilitates asynchronous ICSI cycles, concerns persist regarding its potential adverse effects on sperm quality and reproductive outcomes. This systematic review and meta-analysis aimed to compare ICSI outcomes using fresh and frozen-thawed testicular sperm in men with NOA.
Methods: A systematic search of PubMed Central, Web of Science, and Scopus was performed for studies published between January 1995 and May 2026. Comparative studies evaluating ICSI outcomes using fresh versus frozen-thawed surgically retrieved testicular sperm in NOA patients were included. Outcomes assessed were fertilization rate (FR), cleavage rate (CR), good embryo rate, implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models according to heterogeneity.
Results: Thirty-six studies comprising 5086 ICSI cycles were included. Fresh testicular sperm was associated with significantly higher FR (RR = 1.08, 95% CI 1.02-1.14; p = 0.0069) and LBR (RR = 1.13, 95% CI 1.03-1.23; p = 0.0067) compared with frozen-thawed sperm. No significant differences were observed in CR (RR = 1.01, 95% CI 0.98-1.03), good embryo rate (RR = 1.07, 95% CI 0.99-1.15), IR (RR = 1.00, 95% CI 0.81-1.23), or CPR (RR = 1.10, 95% CI 1.00-1.21; p = 0.054). No significant publication bias was detected.
Conclusion: In men with NOA undergoing ICSI, the use of fresh testicular sperm is associated with improved fertilization and live birth rates compared with frozen-thawed sperm. Nevertheless, embryo development, implantation, and clinical pregnancy outcomes appear comparable between the two approaches. These findings support the preferential use of fresh sperm when feasible, while confirming that cryopreserved sperm remains an effective alternative when fresh sperm utilization is not possible.
在非阻塞性无精子症（NOA）患者中，使用新鲜精子和冷冻解冻睾丸精子进行卵胞浆内单精子注射（ICSI）的最佳选择仍然存在争议。尽管冷冻保存有助于异步ICSI周期，但人们仍然担心其对精子质量和生殖结果的潜在不利影响。本系统综述和荟萃分析旨在比较NOA男性使用新鲜和冷冻解冻睾丸精子进行ICSI的结果。方法：系统检索1995年1月至2026年5月间发表的PubMed Central、Web of Science和Scopus。在NOA患者中使用新鲜和冷冻解冻的睾丸精子评估ICSI结果的比较研究包括在内。评估的结果包括受精率（FR）、卵裂率（CR）、良好胚胎率（良胚率）、着床率（IR）、临床妊娠率（CPR）和活产率（LBR）。根据异质性，使用固定效应或随机效应模型计算95%置信区间（ci）的合并风险比（rr）。结果：36项研究包括5086个ICSI周期。与冷冻解冻精子相比，新鲜睾丸精子的FR （RR = 1.08, 95% CI 1.02-1.14; p = 0.0069）和LBR （RR = 1.13, 95% CI 1.03-1.23; p = 0.0067）显著高于冷冻解冻精子。CR （RR = 1.01, 95% CI 0.98-1.03）、良好胚胎率（RR = 1.07, 95% CI 0.99-1.15）、IR （RR = 1.00, 95% CI 0.81-1.23）、CPR （RR = 1.10, 95% CI 1.00-1.21; p = 0.054）均无显著差异。未发现显著的发表偏倚。结论：在接受ICSI的NOA男性中，与冷冻解冻精子相比，使用新鲜睾丸精子可以提高受精率和活产率。然而，胚胎发育、着床和临床妊娠结局在两种方法之间似乎具有可比性。这些发现支持在可行的情况下优先使用新鲜精子，同时证实在不可能使用新鲜精子时，冷冻保存精子仍然是一种有效的选择。
期刊介绍：
The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species.
The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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