The outcome of sperm retrieval and intracytoplasmic sperm injection for obstructive azoospermia.

OBJECTIVES: To study the outcome of sperm retrieval and intracytoplasmic sperm injection (ICSI) from obstructive azoospermic men. METHOD: Overall, 50 sperm retrieval procedures were performed in 45 obstructive azoospermic men, followed by 57 ICSI procedures with fresh epididymal spermatozoa (n=40), fresh testicular spermatozoa (n=4) or frozen-thawed epididymal spermatozoa (n=13). RESULTS: Sperm retrieval was accomplished via percutaneous epididymal sperm aspiration (PESA) in 42 cases, testicular sperm aspiration (TESA) in 1 case and testicular sperm extraction (TESE) in 2 cases. TESA and TESE were only applied when PESA failed to produce enough spermatozoa for simultaneous ICSI. PESA was successful in 92 per cent of cases. Fertilization rate after ICSI was 79.6 per cent of the metaphase II oocytes. Seventy one embryo transfers were performed using both fresh and frozen thawed embryos resulting in clinical pregnancy in 39.4 per cent. Ongoing pregnancy was achieved in 35.2 per cent. CONCLUSION: ICSI has been shown to give a high fertilization and pregnancy rate with epididymal and testicular spermatozoa retrieved from obstructive azoospermic men. PESA is a noninvasive and simple technique for retrieving spermatozoa from obstructive azoospermic men. Therefore, it is suitable as the primary sperm recovery technique in patients with obstructive azoospermia.