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Impact on using cryopreservation of testicular or epididymal sperm upon intracytoplasmic sperm injection outcome in men with obstructive azoospermia: a systematic review and meta-analysis



To determine whether there was a significant impact on using cryopreservation of testicular or epididymal sperm upon the outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia (OA).


Systematic review and meta-analysis of 20 retrospective studies in databases from January 1, 1995, to June 1, 2020.


Twenty articles were included in this study. A total of 3602 (64.1%) of 5616 oocytes injected with fresh epididymal sperm were fertilized, compared with 2366 (61.2%) of 3862 oocytes injected with cryopreserved sperm (relative risk ratio (RR) 0.96, 95% confidence interval (CI) (0.90, 1.02), P > 0.05). A total of 303 (44.1%) of 687 ICSI cycles using fresh epididymal sperm resulted in a clinical pregnancy, compared with 150 (36.6%) of 410 ICSI cycles using cryopreserved epididymal sperm (RR 0.84, 95% CI (0.72, 0.97), P < 0.05). In the testis, a total of 2147 (68.7%) of 3125 oocytes injected with fresh sperm were fertilized, compared with 1623 (63.5%) of 2557 oocytes injected with cryopreserved sperm (RR 0.97, 95% CI (0.90, 1.06), P > 0.05). A total of 151 (47.8%) of 316 ICSI cycles using fresh testicular sperm resulted in a clinical pregnancy, compared with 113 (38.2%) of 296 ICSI cycles using cryopreserved sperm (RR 0.87, 95% CI (0.72, 1.05), P > 0.05).


In men with OA, there was a statistical lower clinical pregnancy rate (CPR) by using frozen epididymal sperm compared with fresh epididymal sperm, but showing no difference on fertilization rate (FR). Additionally, FR and CPR were not affected by whether the retrieved testicular sperm was frozen or fresh.

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Author information




L.H.C., X.Y., and G.L.Z. made the literature search and data analysis. S.X.Z., L.X.Y., and D.C.H. made study design. L.H.C., X.Y., and G.Y. drew the figures and tables. L.G.H. and G.Y. made the revisions. All authors approved the final version of the paper.

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Correspondence to Yong Gao or Guihua Liu.

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Supplementary Figure S1.

Funnel plots illustrating the meta-analysis of fertilization rate and clinical pregnancy rate on using epididymal or testis sperm in ICSI. a Funnel plot for fertility rate in epididymis. b Funnel plot for clinical pregnancy rate in epididymis. c Funnel plot for fertility rate in testis. d Funnel plot for clinical pregnancy rate in testis (JPG 1403 kb)


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Liu, H., Xie, Y., Gao, L. et al. Impact on using cryopreservation of testicular or epididymal sperm upon intracytoplasmic sperm injection outcome in men with obstructive azoospermia: a systematic review and meta-analysis. J Assist Reprod Genet 37, 2643–2651 (2020).

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  • Cryopreservation
  • Epididymal spermatozoa
  • Intracytoplasmic sperm injection
  • Obstructive azoospermia
  • Testicular spermatozoa