The use of fresh compared to frozen ejaculated sperm has minimal impact on fresh embryo transfer cycle reproductive outcomes

To compare the reproductive outcomes of utilizing fresh versus frozen ejaculated sperm in fresh embryo transfer (ET) cycles. Fresh ET cycles between 2013-2019 from a single institution were reviewed. All fresh, autologous, first time IVF cycles were included, and cycles using donor or surgically retrieved sperm were excluded. Maternal age was stratified as <35, ≥35 to <40 and ≥40 years. Sperm concentration was stratified as ≥15, <15 to ≥5, and <5 mil/ml. Outcomes included clinical intrauterine pregnancy (IUP), miscarriage and live birth. A multivariable logistic regression model was adjusted for developmental stage of embryo at time of transfer and paternal age. A total of 6372 couples were included. Of these, 5957 (93.5%) utilized fresh ejaculated sperm and 415 (6.5%) frozen ejaculated sperm. The proportion using frozen sperm increased with lower sperm concentrations: 212 (4.0%) for ≥15 mil/ml, 54 (12.2%) for <15 to ≥5 mil/ml and 149 (24.4%) for <5 mil/ml. On multivariable logistic regression, fresh ejaculated sperm among those with maternal age >40 and sperm concentrations of <15 to ≥5 mil/ml, were associated with greater odds of a clinical IUP (see Table). No significant differences were observed for miscarriage or live birth. For couples conceiving via fresh ET, the use of fresh versus frozen sperm has minimal impact on cycle outcome unless the male has an abnormal sperm concentration (<15 to ≥5mil/ml) and female is >40 years but no impact on live birth rates.