Cumulative live birth rates following testicular sperm extraction in non-obstructive male infertility.

Only 40 of 168 men with severe infertility fathered a child via TESE-ICSI, taking a median 19.5 months

Journal: European Journal of Obstetrics, Gynecology, and Reproductive Biology | Published: 2026-06-20 | Type: Retrospective Observational Cohort | PMID: 42361535 Authors: Ottou L, Mebroukine S, Ferretti L, Chansel-Debordeaux L, Lambert M, Bernard V, Hocke C, Robert G, Depuydt C, Buffeteau A (Gynecology/ART and Urology Departments, Bordeaux University Hospital) Funding/COI: Funding not listed. Authors declare no competing interests.

Summary

This is an 11-year retrospective look at what actually happens to couples after testicular sperm extraction (TESE) for non-obstructive male infertility, the condition where the testicles aren't producing sperm that reaches the ejaculate at all. Of 168 couples, sperm retrieval worked in just over half, and only 40 men (23.8%) ultimately fathered a child through TESE combined with ICSI. Median time from first TESE to a live birth was 19.5 months.

Claims

• Sperm retrieval was successful in 99 of 168 couples (58.9%)
• 40 men (23.8% of the full cohort) achieved biological fatherhood via TESE-ICSI
• Mean live birth rate per ICSI cycle was 32.8%, with a cumulative live birth rate of 45% after four cycles
• Median time to live birth was 19.5 months from first TESE, 10 months from first ICSI attempt
• 38 men (22.6%) instead achieved fatherhood through donor sperm
• Median time to live birth was 3 years from the first consultation, regardless of whether the couple used TESE or donor sperm

Study Quality

This is a descriptive, single-center retrospective cohort with no comparison group, so it can't establish that TESE-ICSI is better or worse than any alternative. It's tracking outcomes over an 11-year window (2014-2024) without mentioning whether surgical technique, ICSI lab protocols, or patient selection changed over that time, all of which plausibly shift over a decade and could inflate or deflate the pooled numbers. The abstract also states that identifying predictive factors of successful TESE was a study aim, but no such factors are reported here, so that piece of the analysis is either missing from the abstract or wasn't delivered.

The 45% cumulative live birth rate figure is also ambiguous as reported. It's unclear whether the denominator is the 99 couples with successful retrieval, the subset who went on to ICSI, or something else. That distinction matters a lot for how a reader should interpret the number.

Red Flags

• No funding source disclosed, not even "self-funded" or "institutional support," just absent
• 11-year enrollment window with no discussion of protocol changes over time
• Stated aim of identifying predictive factors of TESE success isn't answered in the reported results
• Cumulative live birth rate's denominator isn't clearly specified
• No control or comparator arm, this is purely descriptive
• Single tertiary center, 168 couples, limited generalizability to other clinical settings

Strengths

• Long follow-up capturing full couple trajectories rather than a single ICSI cycle
• Reports cumulative rates across multiple cycles instead of a single, inflated per-cycle number
• Tracks both fatherhood pathways, TESE-ICSI and donor sperm, giving a fuller picture of real-world outcomes for these couples
• Concrete time-to-live-birth data, a metric rarely quantified in this literature

Verdict

A useful real-world data point on how NOA couples actually fare over years, not a practice-changing study. The lack of a clear denominator for the headline 45% figure and the missing predictive-factor analysis the authors said they'd deliver are enough to read the numbers with some caution rather than take them at face value.