To the best of our knowledge, this study is the first in the literature to compare the reproductive outcomes of ejaculated samples given before m-TESE with those obtained through m-TESE in patients with OAT who have two or more recurrent ART/ICSI failures. The overall pregnancy rates and the overall live birth rates were significantly higher in the ejaculate group.
In a study comparing the outcomes of m-TESE, TESA, and ejaculated sperm in ICSI, gestational age, and newborn birthweight were similar between groups, like our study (5). While pregnancy rates and live birth rates were significantly higher in the ejaculated sperm group in our study (5).
In a study comparing synchronous m-TESE, where fresh sperm retrieved during the OPU day or the day before is used for ICSI, with asynchronous ICSI procedures involving sperm freezing and thawing, no significant differences were observed in the number of 2PNs (30.6% vs. 33.0%), the percentage of good-quality embryos (47.6% vs. 40.7%), the clinical pregnancy rate, the live birth rate, or the frequency of fresh and frozen-thawed embryo transfers (9). However, the abortion rate was significantly higher in the asynchronous group (9). In our study, the overall pregnancy rate, overall live birth rate, 5th-day embryo transfer rate, and frozen-thawed cycle frequency were higher in the ejaculated sperm group, while the 3rd-day embryo transfer rate was higher in the m-TESE group.
In a study evaluating the success of TESE-ICSI among the patients with severe oligospermia, 425 of the 714 patients (59.5%) did not have sperm found during the initial TESE procedure. The clinical pregnancy rate was 21.7%, and the live birth rate was 20.6% in this study (18). In our study, sperm could not be found in 32 patients (30.2%) in the m-TESE group. The live birth rate was 22.6%, and the overall pregnancy rate was 33% in patients who underwent m-TESE.
In another study comparing outcomes between sperm obtained from fresh testicular tissue due to severe oligospermia and ejaculate, the pregnancy rate was found to be 24.5% in the ejaculate group and 4.6% in the testis group (19). Like our study, the high pregnancy rates in the ejaculate group suggest that ejaculated sperm, which have completed their maturation process as they pass through the male reproductive system, generally have better fertilization potential than testicular sperm.
In a study evaluating the outcomes of ICSI using fresh or cryopreserved spermatozoa obtained from micro-TESE in patients with severe oligospermia, the sperm retrieval rate by m-TESE was 35.25%. There were no significant differences in patient characteristics, fertilization rates, or embryo quality rates between fresh and frozen cycles. However, higher miscarriage rates (0% vs. 23.81%) and lower live birth rates (75% vs. 50%) were observed in the frozen group than in the fresh group (8). Similarly, in our study, the rate of frozen embryo transfer in the m-TESE group was significantly lower than in the ejaculated sperm group (81.8% vs. 50.8%).
There are numerous publications in the literature comparing m-TESE with conventional methods, and it has been shown that the success rate of sperm retrieval is greater with the m-TESE method (20–23). In studies focusing on Y-chromosome pathologies, m-TESE has been found to be superior to conventional methods (24).
In the study evaluating reproductive outcomes concerning the timing of m-TESE, the mean age of patients was 33.28 ± 4.4 years (range: 22–44 years). The total sperm retrieval rate was 55.4%. Sixteen pregnancies (28.6%) were achieved, resulting in 15 healthy live births (26.8%). The significant factors associated with successful sperm retrieval were marriage duration and infertility duration. Men with severe oligospermia younger than 35.2 years old and a female partner younger than 36.9 years old appeared to have the greatest chance of achieving a healthy birth (7). Similarly, in the present study, among 106 patients who underwent m-TESE, the mean age was 32.33 ± 4.30 years. The cumulative pregnancy rate was 33%, and the live birth rate was 22.6% in the m-TESE group.
In a new study in 2024, Lily et al. and colleagues investigated the importance of TESE timing, finding somewhat higher rates of sperm retrieval (69% vs 62%) and fertilization (53% vs 45%) in the group where TESE was performed on the day of oocyte pick-up (OPU). However, there was no significant difference in clinical pregnancy rates (43% vs 45%) or live birth rates (43% vs 42%). Therefore, the study concluded that there is no significant clinical difference for clinicians between performing TESE on the day of OPU or one day prior (25). In our study, TESE was performed on all patients on the day of OPU.
Limitations
Due to retrospective file scanning, the potential limitation of the study was the exclusion of some patients due to incomplete recording of certain parameters. However, to the best of our knowledge, our study is the first to evaluate ejaculate outcomes on the morning of TESE in conjunction with micro-TESE.
As a result, the reproductive outcomes of motile sperm obtained before m-TESE were also found to be highly successful. Counseling families about the risks of miscarriage and abortions before m-TESE and recommending ICSI with ejaculate before TESE can be considered even for severe OAT patients.