# The ejaculate obtained on the morning of microdissection testicular sperm extraction (m-TESE) or m-TESE itself in repeated intracytoplasmic sperm injection failure due to severe male infertility? A retrospective study

## TL;DR

This study compares ICSI outcomes in men with severe infertility using sperm from morning ejaculate versus m-TESE, finding that morning ejaculate may lead to better pregnancy and birth rates.

## Contribution

The study provides new evidence that morning ejaculate can be more effective than m-TESE in certain severe infertility cases.

## Key findings

- Embryo transfer rates on day three were significantly higher in the m-TESE group.
- Overall pregnancy and live birth rates were significantly higher in the ejaculate group.
- Morning ejaculate may be preferable for severe OAT patients with prior ART failures.

## Abstract

To compare intracytoplasmic sperm injection (ICSI) outcomes between oligoasthenoteratozoospermic (OAT) men with recurrent assisted reproductive technology (ART) failures who underwent ICSI using sperm from the ejaculate on the day of a planned microdissection testicular sperm extraction (m-TESE) vs sperm obtained via m-TESE.

We reviewed the outcomes of men who underwent ICSI using either ejaculate or m-TESE due to OAT and recurrent ART failure at the Department of Reproductive Endocrinology, Gülhane Training and Research Hospital, between November 2016 and January 2024. The study enrolled 172 men: 66 men in the ejaculate group and 106 in the m-TESE group. All patients had fewer sperm parameters in two subsequent semen analyses.

The groups did not significantly differ in terms of female (P = 0.631) or male (P = 0.655) age. Sperm was obtained from 76/106 men in the m-TESE group (69.81%). The embryo transfer rate on day three was significantly higher in the m-TESE group (32.2% vs 8.3%; P = 0.003), whereas, on day five, it was significantly higher in the ejaculate group (61.7% vs 37.9%; P = 0.015). The ejaculate group had significantly higher overall pregnancy rates (59.1% vs 33%; P = 0.001) and overall live birth rates (37.9% vs 22.6%; P = 0.031).

In recurrent ICSI failure, the reproductive success of ejaculate was higher than that of m-TESE. If it contains motile spermatozoa, the ejaculate before m-TESE could be considered even in severe OAT patients with two or more ART/ICSI failures.