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Sperm Activation with Pentoxifylline Is Beneficial For Non-Obstructive Azoospermia Patients Using Testicular Sperm before Intracytoplasmic Sperm Injection

Purpose: This study aimed to assess the efficacy and safety of sperm activation with pentoxifylline (PF) for non-obstructive azoospermia (NOA) patients that underwent testicular sperm aspiration (TESA) for intracytoplasmic sperm injection (ICSI) in in vitro fertilization (IVF) program. Methods: A total of 457 patients with 457 TESA- ICSI cycles who identified no motile spermatozoa under through scrutiny were included and divided into two groups. 121 cycles without PF treatment were recorded as control group. The other 336 cycles with PF treatment were recruited as PF group. The two groups were compared for demographics, routine parameters of IVF treatment, pregnancy rates, and neonatal outcomes. Results: The rates of fertilization, 2PN fertilization, D3 oocyte utilization and good-quality embryo in PF group were significantly higher than the control group (P < 0.05). Moreover, PF significantly reduced the total fertilization failure cycle rate, rate of cycles with no transferable embryo and the mean ICSI time per oocyte when compared with the control group (P < 0.05). Although no significant differences were observed between the two groups in the implantation rate, clinical pregnancy rate, miscarriage rates and live birth rate (P > 0.05), significantly increased cumulative live birth rate were found in the PF group (P > 0.05). Neonatal outcomes were comparable between the two groups, and no congenital anomalies were reported in the two groups. Conclusion: Sperm activation with pentoxifylline is beneficial for NOA patients who underwent TESA- ICSI treatment. However, further research with larger groups of couples to assess the long-term effect were still required.