Retrospective cohort study of intracytoplasmic sperm injection outcomes using testicular vs. ejaculated sperm among patients with non-obstructive azoospermia or cryptozoospermia

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 vs. those who proceeded directly to mTESE.