ArticleTranslational andrology and urology2026
Retrospective cohort study of intracytoplasmic sperm injection outcomes using testicular
Article in Translational andrology and urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-obstructive azoospermia (NOA) represents the most severe form of male infertility, for which microsurgical testicular sperm extraction (mTESE) is the standard treatment. Extended sperm search and micro-freeze (ESSM) offers a non-invasive alternative for identifying rare spermatozoa in ejaculate, but its clinical utility as an initial intervention prior to mTESE remains uncertain. This study compares sperm identification rates and intracytoplasmic sperm injection (ICSI) outcomes among men with NOA or cryptozoospermia who underwent ESSM as an initial intervention Methods: A retrospective cohort study of 73 male patients with NOA or cryptozoospermia severe enough to qualify for mTESE at NYU Langone Fertility Center between 2018 and 2024. Patients were categorized based on their initial intervention: ESSM-first group (n=45), in which ESSM was attempted prior to surgical retrieval, and an mTESE-first group (n=28), in which patients proceeded directly to surgery. The primary outcome was overall sperm identification rate per patient. Secondary outcomes included sperm retrieval success from mTESE after failed ESSM, and among patient proceeding to in vitro fertilization (IVF) with ICSI, fertilization rate, blastocyst formation rate, euploid rate, and live birth rate. Results: The stepwise ESSM-first strategy was associated with a higher overall sperm identification rate compared with proceeding directly to mTESE (76% Conclusions: In men with NOA or cryptozoospermia eligible for surgical sperm retrieval, an ESSM-first strategy was associated with higher overall sperm identification rates while preserving comparable reproductive outcomes among those proceeding to IVF with ICSI. These findings support consideration of ESSM as an initial, non-invasive strategy prior to mTESE in appropriately selected patients.
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