Introduction
In ART (Assisted Reproductive Technology), the origin of the sperm as well as its condition before retrieval impact fertilization and pregnancy rates. The objective of this study was to assess the clinical and biological results of ICSI cycles based on the sperm source in a Moroccan fertility center. The sperm sources included fresh and frozen–thawed ejaculated sperm along with frozen testicular sperm.

Methods
This was a retrospective study at Boudra Fertility Center, Fez, Morocco, which included all ICSI cycles completed between January 2019 and December 2024. A total of 745 ICSI cycles from 502 infertile couples were analyzed. Cycles were classified into three groups based on the sperm sources: fresh ejaculated sperm: 662 cycles; frozen–

thawed ejaculated sperm: 24 cycles; and frozen testicular sperm obtained via biopsy: 59 cycles. The outcomes included rates of fertilization, embryo development, clinical pregnancy, and live births.

Results:

The rates of fertilization were as follows: fresh sperm: 59.83%; frozen sperm: 48.53%; and testicular sperm: 45.96%. The clinical pregnancy rates were 32.63% with fresh sperm, 25.00% with frozen sperm, and 25.42% with testicular sperm. Birth rates were 30.36% (fresh sperm), 25.00% (frozen sperm), and 20.34% (testicular sperm). While outcomes were slightly lower with frozen and testicular sperm, viable pregnancies and live births were achieved across all groups.

Conclusion:

This five-year analysis shows that ICSI outcomes are affected by the origin and cryopreservation of the sperm used. Fresh sperm clearly had the highest rates of fertilization and live births; however, clinical outcomes maternally and perinatally, as concerns maternal health, were satisfactory with both frozen and testicular sperm. These findings allow for increasing the use of cryopreserved and testicular sperm in ART for fresh cases when samples are not available.