Fresh testicular sperm retrieved from men with spinal cord injury retains equal fecundity to that from men with obstructive azoospermia via intracytoplasmic sperm injection

ObjectiveTo examine the outcomes of intracytoplasmic sperm injection (ICSI) with testicular sperm retrieved from men with spinal cord injury.DesignRetrospective study.SettingPrivate hospital-based infertility research laboratory.Patient(s)Twenty-two couples of whom one partner was a man with spinal cord injury (SCI).Intervention(s)Reviewing the outcomes of testicular sperm extraction (TESE)–ICSI.Main Outcome Measure(s)Testicular sperm retrieval rate, fertilization rate, pregnancy rate, comparison with patients with obstructive azoospermia.Result(s)Testicular sperm were retrieved from 19 of 22 (86%) patients with SCI. Intracytoplasmic sperm injection resulted in a fertilization rate of 236 of 364 (65%). Of 19 couples, 14 couples achieved 18 pregnancies, and 22 infants (14 singleton and 4 twin) were born. (Pregnancy per couple was 74% and that per ICSI was 54%). There was no significant difference in pregnancy rate at the first ICSI between SCI couples and obstructive azoospermia couples (68% SCI, 68% obstructive azoospermia). However, pregnancy rate per fresh testicular sperm–ICSI was significantly higher than that per frozen-thawed sperm–ICSI in SCI couples (64% SCI fresh, 25% SCI frozen-thawed) although no significant difference was seen in obstructive azoospermia couples (76% obstructive azoospermia fresh, 63% obstructive azoospermia frozen-thawed). There was no significant difference in pregnancy rate between fresh ET cycle and frozen-thawed ET cycle in SCI couples.Conclusion(s)Testicular sperm in men with SCI may possess disadvantages in freezing and thawing compared with that in men with obstructive azoospermia. Fresh testicular sperm–ICSI may offer optimum outcome for SCI couples desirous of pregnancy.