Association of sperm source with miscarriage and take-home baby after ICSI in cryptozoospermia: a meta-analysis of testicular and ejaculated sperm.

BACKGROUND: Miscarriage and take-home baby are the most important issues to patients with cryptozoospermia in receiving intracytoplasmic sperm injection (ICSI). The ICSI usually use ejaculated or testicular sperm. Unfortunately, no synthesized evidence reported miscarriage and take-home baby rate between the two sperm sources.

OBJECTIVES: This study aimed to compare the miscarriage and take-home baby rate of ICSI using testicular and ejaculated sperm in patient with cryptozoospermia.

MATERIALS AND METHODS: We conducted meta-analyses that were based on data from Cochrane library, Ovid, PubMed, ScienceDirect, Scopus, and Web of Science. The pooled analyses used risk ratio (RR) in random-effects model. Sensitivity analyses by subgrouping were completed to explore the associations between mean age and outcome.

RESULTS: This study identified 331 potential citations and included four cohort studies for qualitative and quantitative synthesis. The four studies involved 331 patients with 479 ICSI cycles. The results showed no significant difference in miscarriage between testicular sperm group and ejaculated sperm group (RR = 1.06, 95% CI 0.48-2.35, p = 0.88). Yet, take-home babies per embryo transfer in testicular sperm group (53/226, 23.45%) was more than ejaculated sperm group (59/429, 13.75%) (RR = 1.72, 95% CI 1.21-2.44, p = 0.002). Similar results can be found in take-home babies per ICSI cycle (RR = 1.77, 95% CI 1.28-2.44, p = 0.0005), especially in younger couple (RR = 1.93, 95% CI 1.11-3.34, p = 0.02). No small study bias was detected in the analyses.

DISCUSSION: This study found that testicular sperm has more advantage for ICSI in patients with cryptozoospermia, especially in younger couple. These findings may help guide us when deciding the optimal method of sperm harvest for men with cryptozoospermia.

CONCLUSION: Comparing to ejaculated sperm, testicular sperm showed benefits for take-home baby rate, but not for miscarriage in patients with cryptozoospermia.