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Reproductive outcomes of intracytoplasmic sperm injection using testicular sperm and ejaculated sperm in patients with AZFc microdeletions: a systematic review and meta-analysis

Yu Zhou1,2, Cun-Can Deng2,3, Wu-Jiang Liu2, Huang Liu2, Hou-Bin Zheng2, Yun-Ge Tang2, Xin-Zong Zhang2, Jun-Hong Deng4

1 Department of Urology, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
2 NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
3 Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
4 Department of Andrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China

Correspondence: Dr. XZ Zhang (13857170787@139.com) or Dr. JH Deng (2507297450@qq.com)



Studies have explored the assisted reproductive technology (ART) outcomes of Y-chromosome azoospermia factor c (AZFc) microdeletions, but the effect of sperm source on intracytoplasmic sperm injection (ICSI) remains unknown. To determine the ART results of ICSI using testicular sperm and ejaculated sperm from males with AZFc microdeletions, we searched Embase, Web of Science, and PubMed to conduct a systematic review and meta-analysis. The first meta-analysis results for 106 cycles in five studies showed no significant differences in the live birth rate between the testicular sperm group and the ejaculated sperm group (risk ratio: 0.97, 95% confidence interval [CI]: 0.73–1.28, P = 0.82). The second meta-analysis of 106 cycles in five studies showed no difference in the abortion rate between the testicular sperm group and ejaculated sperm group (risk ratio: 1.06, 95% CI: 0.54–2.06, P = 0.87). The third meta-analysis of 386 cycles in seven studies showed no significant difference in clinical pregnancy rates between the testicular sperm group and the ejaculated sperm group (risk ratio: 1.24, 95% CI: 0.66–2.34, P = 0.50). Inevitable heterogeneity weakened our results. However, our results indicated that testicular sperm and ejaculated sperm yield similar ART outcomes, representing a meaningful result for clinical treatment. More properly designed studies are needed to further confirm our conclusions.

Keywords: assisted reproductive technology; azoospermia factor c microdeletions; ejaculated sperm; live birth rate; testicular sperm

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