{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:10:46Z","timestamp":1790611846075,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Using testicular sperm, men with azoospermia can father children. Sperm cryopreservation helps avoid the risk of cycle canceling because of the failure of testicular sperm retrieval. However, cryopreservation of testicular sperm can potentially impair sperm function. In addition, the different qualities of testicular sperm retrieved from men with various etiologies of azoospermia can lead to different intracytoplasmic sperm injection (ICSI) outcomes after sperm cryopreservation. A retrospective analysis was performed to elucidate the influence of frozen testicular sperm from men with different etiologies of azoospermia on assisted reproductive technology (ART) treatment outcomes. Testicular sperm retrieval rates were also compared. The fertilization rate was found to be influenced by testicular sperm cryopreservation in most cases, especially for patients with azoospermia factor c (AZFc) deletion, and embryo development was significantly impeded when frozen testicular sperm from Klinefelter syndrome (KS) patients were used. Moreover, ART treatment outcomes after embryo transfer were not significantly influenced by testicular sperm cryopreservation for any of the etiologies. In addition, significantly higher sperm retrieval rates were achieved in cryptorchidism, KS, and AZFc deletion patients, whereas the testicular sperm retrieval rate was significantly lower in patients with idiopathic nonobstructive azoospermia. Collectively, our findings suggest that except for patients with KS, testicular sperm retrieval prior to initiating ovarian stimulation of the patient\u2019s partner should be considered the first-line approach. In addition, assisted oocyte activation should be performed in ICSI cycles using frozen testicular sperm, especially for patients with AZFc deletion.<\/jats:p>","DOI":"10.4103\/aja2025120","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:00:10Z","timestamp":1777996810000},"page":"651-659","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Fresh or frozen testicular sperm? Guidance from an etiology-classified retrospective study on ICSI cycles for patients with azoospermia"],"prefix":"10.4103","volume":"28","author":[{"given":"Zi-Jue","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Andrology, Center for Men\u2019s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Hong","family":"Ma","sequence":"additional","affiliation":[{"name":"Ningxia Human Sperm Bank, Department of Urology, General Hospital of Ningxia Medical University, Yinchuan 750001, China"},{"name":"Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education in Ningxia Medical University, Yinchuan 750001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cun-Zhong","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Andrology, Center for Men\u2019s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Rong","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Andrology, Center for Men\u2019s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Andrology, Center for Men\u2019s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Na","family":"Zhou","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Jin","family":"He","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Andrology, Center for Men\u2019s Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"},{"name":"Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"R1-20260905","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/humrep\/deaf212","article-title":"Recommendations from the WHO guideline for the prevention, diagnosis, and treatment of infertility","volume":"41","author":"Mburu","year":"2026","journal-title":"Hum Reprod"},{"key":"R2-20260905","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1093\/humrep\/14.7.1794","article-title":"Testicular sperm retrieval and cryopreservation prior to initiating ovarian stimulation as the first line approach in patients with non-obstructive azoospermia","volume":"14","author":"Ben-Yosef","year":"1999","journal-title":"Hum Reprod"},{"key":"R3-20260905","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0015-0282(99)00564-6","article-title":"Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection","volume":"73","author":"K\u00fcpker","year":"2000","journal-title":"Fertil Steril"},{"key":"R4-20260905","first-page":"486","article-title":"Cumulative live birth rate after IVF \u2013 trend over time and the impact of blastocyst culture and vitrification","volume":"36","author":"Saket","year":"2021","journal-title":"Hum Reprod"},{"key":"R5-20260905","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1023\/A:1013107132110","article-title":"Efficiency of using frozen-thawed testicular sperm for multiple intracytoplasmic sperm injections","volume":"18","author":"Fukunaga","year":"2001","journal-title":"J Assist Reprod Genet"},{"key":"R6-20260905","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1530\/jrf.0.1120011","article-title":"Production of normal offspring from mouse oocytes injected with spermatozoa cryopreserved with or without cryoprotection","volume":"112","author":"Wakayama","year":"1998","journal-title":"J Reprod Fertil"},{"key":"R7-20260905","doi-asserted-by":"crossref","first-page":"11061","DOI":"10.3390\/ijms241311061","article-title":"Cryopreservation of ovarian and testicular tissue and the influence on epigenetic pattern","volume":"24","author":"Trapphoff","year":"2023","journal-title":"Int J Mol Sci"},{"key":"R8-20260905","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1439-0272.2009.01014.x","article-title":"IVF outcome with cryopreserved testicular sperm","volume":"43","author":"Levron","year":"2011","journal-title":"Andrologia"},{"key":"R9-20260905","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/S0015-0282(97)81859-6","article-title":"Quality of frozen-thawed testicular sperm and its preclinical use for intracytoplasmic sperm injection into in vitro-matured germinal-vesicle stage oocytes","volume":"67","author":"Verheyen","year":"1997","journal-title":"Fertil Steril"},{"key":"R10-20260905","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s10815-005-7481-y","article-title":"Optimal use of fresh and frozen-thawed testicular sperm for intracytoplasmic sperm injection in azoospermic patients","volume":"22","author":"Wu","year":"2005","journal-title":"J Assist Reprod Genet"},{"key":"R11-20260905","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/ijgo.12537","article-title":"Application of testicular spermatozoa cryopreservation in assisted reproduction","volume":"142","author":"Yu","year":"2018","journal-title":"Int J Gynecol Obstet"},{"key":"R12-20260905","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.tjog.2012.08.003","article-title":"Pregnancy outcome and neonatal data of children born after intracytoplasmic sperm injection with a different duration of cryopreservation of spermatozoa obtained through testicular sperm extraction","volume":"52","author":"Tsai","year":"2013","journal-title":"Taiwan J Obstet Gynecol"},{"key":"R13-20260905","doi-asserted-by":"crossref","first-page":"131","DOI":"10.6061\/clinics\/2013(Sup01)15","article-title":"Cryopreservation of testicular and epididymal sperm: techniques and clinical outcomes of assisted conception","volume":"68","author":"Gangrade","year":"2013","journal-title":"Clinics"},{"key":"R14-20260905","doi-asserted-by":"crossref","first-page":"e13849","DOI":"10.1111\/and.13849","article-title":"Testicular sperm retrieval: what should we expect from the fresh and subsequent cryopreserved sperm injection?","volume":"53","author":"Aizer","year":"2021","journal-title":"Andrologia"},{"key":"R15-20260905","doi-asserted-by":"crossref","first-page":"1613293","DOI":"10.3389\/fpubh.2025.1613293","article-title":"Structural imbalance of medical resources amid population mobility and digital empowerment: a study of national and port-developed provinces in China","volume":"13","author":"Fu","year":"2025","journal-title":"Front Public Health"},{"key":"R16-20260905","doi-asserted-by":"crossref","first-page":"533","DOI":"10.4103\/aja2021101","article-title":"Clinical benefits of a modified cryopiece system for cryopreservation of rare ejaculated and testicular spermatozoa for ICSI","volume":"24","author":"Chen","year":"2022","journal-title":"Asian J Androl"},{"key":"R17-20260905","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1111\/andr.12380","article-title":"Successful delivery derived from cryopreserved rare human spermatozoa with novel cryopiece","volume":"5","author":"Sun","year":"2017","journal-title":"Andrology"},{"key":"R18-20260905","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.21037\/tau-20-1080","article-title":"Cryopiece, a novel carrier with faster cooling rate, high recovery rate and retrieval rate, for individual sperm cryopreservation","volume":"10","author":"Zhu","year":"2021","journal-title":"Transl Androl Urol"},{"key":"R19-20260905","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.3390\/cells13181582","article-title":"Successful sperm retrieval and clinical pregnancies following micro-TESE and ICSI treatments in patients with nonobstructive azoospermia due to various etiologies","volume":"13","author":"Liu","year":"2024","journal-title":"Cells"},{"key":"R20-20260905","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.fertnstert.2013.11.123","article-title":"Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction","volume":"101","author":"Ramasamy","year":"2014","journal-title":"Fertil Steril"},{"key":"R21-20260905","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/j.fertnstert.2005.05.053","article-title":"Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter's syndrome","volume":"84","author":"Okada","year":"2005","journal-title":"Fertil Steril"},{"key":"R22-20260905","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/JU.0000000000003737","article-title":"Age, sperm retrieval, and testicular histology in Klinefelter syndrome","volume":"211","author":"Kang","year":"2024","journal-title":"J Urol"},{"key":"R23-20260905","first-page":"412","article-title":"Clinical outcomes of 77 TESE treatment cycles in non-mosaic Klinefelter syndrome patients","volume":"26","author":"Barros","year":"2022","journal-title":"JBRA Assist Reprod"},{"key":"R24-20260905","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1038\/s41586-024-08104-6","article-title":"How the extra X chromosome impairs the development of male fetal germ cells","volume":"635","author":"Lu","year":"2024","journal-title":"Nature"},{"key":"R25-20260905","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40537-019-0192-5","article-title":"Survey on deep learning with class imbalance","volume":"6","author":"Johnson","year":"2019","journal-title":"J Big Data Ger"},{"key":"R26-20260905","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.ins.2019.11.004","article-title":"Data imbalance in classification: experimental evaluation","volume":"513","author":"Thabtah","year":"2020","journal-title":"Inform Sci"},{"key":"R27-20260905","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1038\/s41592-021-01302-4","article-title":"The class imbalance problem","volume":"18","author":"Megahed","year":"2021","journal-title":"Nat Methods"}],"container-title":["Asian Journal of Andrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aja2025120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:00:26Z","timestamp":1788598826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aja2025120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aja2025120","relation":{},"ISSN":["1008-682X","1745-7262"],"issn-type":[{"value":"1008-682X","type":"print"},{"value":"1745-7262","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]},"assertion":[{"value":"2025-11-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}