EFFICACY OF MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION (MESA) AND INTRACYTOPLASMIC SPERM INJECTION (ICSI) IN OBSTRUCTIVE AZOOSPERMIA

Purpose: Our purpose was to test whether micromanipulation using subzo nal insemination and intracytoplasmic sperm injection could improve th e poor fertilization and pregnancy rates obtained when attempting in v itro fertilization in patients with congenital absence of the vas defe rens and unreconstructable obstructive azoospermia with microsurgicall y retrieved epididymal spermatozoa. Results: Conventional in vitro fer tilization (group A; 14 cycles), subzonal insemination (group B; 13 cy cles), and intracytoplasmic sperm injection (group C; 28 cycles) were carried out in 55 treatment cycles. Fertilization rates for groups A, B, and C were 16.1, 31.4, and 48.6%, respectively (P < 0.05). Clinical pregnancy rates for groups A, B, and C were 7.1, 7.7, and 32.1% (P < 0.05), respectively. In five cycles, intracytoplasmic sperm injection using epididymal sperm from alloplastic spermatoceles was performed an d two clinical pregnancies (40%) were obtained. Conclusions: The combi ned microsurgical epididymal sperm aspiration and intracytoplasmic spe rm injection procedure is highly effective in improving the fertilizat ion and pregnancy rate in congenital absence of the vas deferens and u nreconstructable obstructive azoospermia. Furthermore, alloplastic spe rmatoceles may be useful for repeat sperm aspirations.