SIMPLIFIED SPERM RETRIEVAL AND INTRACYTOPLASMIC SPERM INJECTION IN PATIENTS WITH AZOOSPERMIA

Objective To evaluate the rate of recovery of spermatozoa from the epi didymis using a percutaneous aspiration technique and to assess the fe rtilization rate following intracytoplasmic sperm injection (ICSI). Pa tients and methods Forty-two patients with azoospermia underwent a tot al of 46 treatment cycles of in vitro fertilization (IVF) and ICSI, Th e sperm used for ICSI was retrieved percutaneously by fine-needle aspi ration and syringe suction (percutaneous epididymal sperm aspiration, PESA) from the epididymis in 28 patients (mean age 34.9 years), over 3 2 cycles, Six patients underwent microsurgical sperm aspiration (MESA) and in the remaining eight patients, neither percutaneous aspiration nor MESA yielded suitable sperm and spermatozoa extracted from testicu lar biopsy were used. Results A total of 362 oocytes were collected an d of those, 286 (79%) were subjected to ICSI. Of the injected oocytes, 49 (17.2%) mere damaged, 138 (48.3%) achieved normal fertilization an d, of those, 112 (81.2%) cleaved, A total of 67 embryos were transferr ed and 18 more were suitable for cryopreservation, Of the 25 cycles wi th embryo transfer, eight resulted in a pregnancy and of these, one mi scarried. The pregnancy rate was 25% per cycle and 32% per embryo tran sfer. The implantation rate was 12%, Conclusions This extensive series of PESA/ICSI cycles indicates that PESA can be used successfully to r etrieve spermatozoa in patients with azoospermia. The technique is sim ple, cost-effective and is associated with fewer complications compare d to an open microsurgical procedure.