INTRACYTOPLASMIC SPERM INJECTION USING MICROSURGICALLY RETRIEVED EPIDIDYMAL AND TESTICULAR SPERM

Objective: To evaluate treatment of couples who are infertile due to u nreconstructable obstructive azoospermia with microsurgical epididymal sperm aspiration or testicular sperm and intracytoplasmic sperm injec tion (ICSI). Design: Prospective. Setting: The Egyptian IVF-ET Center in association with Cairo University. Patients: Twenty-three couples w ho are infertile due to obstructive azoospermia in which reconstructiv e microsurgery failed or was not possible. Interventions: Microsurgica l epididymal or testicular sperm retrieval and ICSI in 24 cycles. Main Outcome Measures: Fertilization and pregnancies. Results: All 24 cycl es had successful fertilization and reached the ET stage. In microsurg ical epididymal sperm aspiration cases, fertilization rate per metapha se II oocyte was 63% (109/172). Six patients became pregnant, includin g one set of twins and one set of triplets. One pregnancy resulted fro m the use of cryothawed epididymal sperm. In testicular sperm aspirati on cases, the fertilization rate was 59% (32/54) and four clinical pre gnancies resulted. Conclusion: The use of microepididymal sperm aspira tion or testicular sperm aspiration in conjunction with ICSI provide a highly precise and efficient procedure for achieving pregnancy in cas es of unreconstuctable obstructive azoospermia.