Introduction: Microsurgical testicular sperm extraction (m-TESE) is the gold standard treatment for male patients with Non-Obstructive Azoospermia (NOA). The published success rates of this procedure are typically reported as sperm retrieval rates (SRR), which is estimated to be 50%. However, since motile or twitching sperm is preferentially selected for ICSI and testicular sperm retrieved is often non-motile or of poor morphology it leads to complex decisions for embryologists. SRR does not accurately capture the success of this procedure as measured by pregnancy and live birth outcomes. Our primary objective is to assess the motility of sperm retrieved from m-TESE at the time of fresh m-TESE (same day as egg retrieval) compared to the motility of sperm post thaw from frozen m-TESE cases (sperm is retrieved ahead of egg retrieval with subsequent cryopreservation) . The secondary outcomes include pregnancy and live birth rates. Methods: We retrospectively reviewed our electronic records of m-TESE procedures performed between 2007-2021.Patients with obstructive azoospermia and cryptozoospermia were excluded. We reviewed all cases with retrieved sperm and recorded motility assessment for those cases. Sperm motility was classified as motile sperm, twitching sperm, or tail sway (sperm with distinctly flexible tail). We compared the motility and ICSI outcomes between fresh m-TESE and frozen-thaw m-TESE. Results: 129 m-TESE surgeries were performed on 114 patients with NOA. 31 m-TESEs were performed fresh and 98 were performed ahead of time with sample freezing for subsequent ICSI cycle. SRR from “fresh” cases was 58%, while SSR from frozen-thaw cycles was 44.8% (p=0.200). Motile sperm (Motile sperm, Twitching sperm and Tail Sway) was obtained in 58% of “fresh” cases. Motile sperm was found for “frozen” mTESE in 37% of cases when examined on day of surgery and 19.3% of cases on post-thaw. Pregnancy and live birth rate were 55.5% and 27.7% respectively for “fresh” cases and 27% and 21.6% respectively for frozen-thaw cases (p-value <0.05 and 0.6140). Conclusions: Patients scheduled for frozen-thaw ICSI cycle had lower rates of obtaining motile sperm for ICSI, pregnancy and live births compared to patients undergoing for fresh m-TESE at one institution. These results help inform our counseling and treatment strategy for patients with non-obstructive azoospermia. SOURCE OF Funding: N/A
