Evaluation of vitality in testicular and ejaculated sperm for intracytoplasmic sperm injection in the case of totally or initially immotile spermatozoa in the ejaculate

Totally immotile spermatozoa in the ejaculate is a good indication for intra cytoplasmic sperm injection (ICSI). However, low vitality of spermatozoa results in low fertilization and pregnancy rates. The high number of totally immotile sperm in the ejaculate is mostly thought to be degenerative due to the long duration of epididymal transport. Whereas totally immotile testicular spermatozoa are probably immotile and can still gain motility during maturation. The aim of this study was to assess the vitality of ejaculated and testicular sperm in patients with totally immotile spermatozoa in their ejaculate. Furthermore, the vitality of these samples was evaluated for suitability with ICSI to obtain fertilization and pregnancy. In the totally immotile testicular sperm group the mean vitality was 79.1% (range:62-94%). However, the vitality in the totally immotile ejaculated sperm group was found to be as low as 23.2% in the same patients. In the initially immotile sperm group where only ejaculated samples were evaluated, the mean vitality was 49.7% (range:25-80%). As a conclusion a higher and a statistically significant (p<0.01) vitality was obtained with testicular spermatozoa. This may suggest that totally immotile ejaculated sperm after preparation are mostly degenerative while testicular spermatozoa are immature but have a higher vitality. Thus, testicular sperm may be considered preferential to ejaculated totally immotile and low vital spermatozoa after preparation as it provides a higher number of vital spermatozoa for fertilization with ICSI.