Frozen vs Fresh Sperm: Success Rates for IUI, IVF and ICSI

With IVF and ICSI, outcomes with frozen sperm are close to fresh in large datasets. IUI is more affected, because freezing reduces the number of moving sperm.

Key takeaways

• IVF: a 2024 matched study of conventional IVF found live birth rates of 40.3% with frozen sperm and 42.4% with fresh sperm, a non-significant difference. The HFEA says IVF with frozen sperm is as successful as fresh.
• ICSI: a 2024 analysis of 44,423 donor-egg ICSI cycles found slightly lower rates with frozen sperm, which the authors judged clinically limited. For testicular sperm, a meta-analysis of 17 studies found no difference in live births.
• IUI: most affected. Frozen samples carry far fewer moving sperm, and time to pregnancy was longer in a 5,335-cycle analysis.
• The biggest factor in any of these is the age of the person providing the eggs, not whether the sperm was frozen.
• Study averages cannot be used to compare clinics. Ask each clinic for its own data by age.

Why freezing affects some treatments more than others

Freezing and thawing reduce the number of moving sperm in a sample. Typically a quarter to a half of motile sperm survive, as explained in does freezing damage sperm?. How much that matters depends on how many sperm a treatment needs:

IUI: the treatment most affected

The largest recent analysis comes from Massachusetts General Hospital (Cherouveim et al., Frontiers in Reproductive Health, 2023), covering 5,335 IUI cycles from 2004 to 2021, of which 1,871 used frozen sperm.

• The total motile count was much lower with frozen samples: an average of 14.3 million versus 65.0 million for fresh.
• Unadjusted clinical pregnancy rates were 9.4% per cycle with frozen sperm versus 13.0% with fresh.
• After adjusting for other factors, the overall difference was not statistically significant, but frozen samples needed more cycles on average (3.84 versus 2.58), and a disadvantage remained in cycles using oral ovulation medication.
• Miscarriage rates did not differ significantly.

If you expect to use IUI, more stored vials means more attempts. See how many samples to freeze.

IVF with frozen sperm

A 2024 study from Shanghai Ninth People’s Hospital (Frontiers in Endocrinology) compared conventional IVF cycles using frozen-thawed ejaculated sperm with matched cycles using fresh sperm. In the frozen embryo transfer analysis:

• Live birth rate: 40.3% (83 of 206) with frozen sperm versus 42.4% (278 of 655) with fresh sperm, not statistically different.
• Clinical pregnancy rate: 44.7% versus 51.8%, also not statistically different.

This matches the HFEA’s statement that IVF using frozen sperm is just as successful as IVF using fresh sperm.

ICSI with frozen sperm

A retrospective analysis of 44,423 oocyte-donation ICSI cycles published in 2024 found that cryopreserved ejaculated sperm was associated with statistically significant but slight decreases in pregnancy and live birth rates, which the authors described as clinically limited. Using donor eggs removes much of the variation from egg quality, which is why this dataset is informative.

For sperm retrieved surgically from the testis in men with non-obstructive azoospermia, a 2018 meta-analysis of 17 studies found no difference in live birth rates between fresh and frozen-thawed sperm (risk ratio 1.11, 95% confidence interval 0.88 to 1.41).

What these numbers do not tell you

• Your own chances. Outcomes depend most on the age of the person providing the eggs, the cause of infertility and the quality of your thawed sample. A fertility specialist can interpret your post-thaw test.
• Which clinic is better. UK advertising guidance from the CAP, ASA, HFEA and CMA warns against comparing clinics on headline success rates, and HFEA guidance tells clinics to say that such data is of limited value for choosing. Ask each clinic for live birth rates by age group, the year, and the number of patients treated.
• Long-term storage effects. Births have followed more than 26 years of storage (Guinness lists 27 years and 195 days), and storage time does not appear to reduce survival. See how long sperm can be frozen.

Practical steps

1. Ask your bank for the post-thaw motile count of a test vial, in writing.
2. Ask a fertility specialist which treatment that count supports: IUI, IVF or ICSI.
3. If you are still deciding whether to freeze, compare the cost with the calculator and read is sperm freezing worth it?