FERTILITY WITH TESTICULAR SPERM EXTRACTION AND INTRACYTOPLASMIC SPERMINJECTION IN NONOBSTRUCTIVE AZOOSPERMIC MEN

In non-obstructive azoospermia spermatozoa can usually only be isolate d from the testicles, and thus the most promising treatment model is t esticular sperm extraction (TESE). Hormone concentrations, testicular volume determinations and testicular biopsy results are not uniform en ough to select potential candidates for successful TESE and intracytop lasmic sperm injection (ICSI) approaches in advance. The aim of this s tudy was to assess the efficacy of using ICSI with testicular spermato zoa in eases of non-obstructive azoospermia and to compare the inclusi on criteria and sperm existence in the testicles in sperm obtainable a nd non-obtainable groups, All men showed either complete or incomplete (n = 14) maturation arrest in spermatogenesis, severe hypospermatogen esis (n = 10) or Sertoli cell-only syndrome (n = 5) in their testicula r biopsies, Only 14 out of a total of 29 men provided enough spermatoz oa for the ICSI procedure, while no spermatozoa were found in the test icular samples of the remaining 15 men, Out of 123 oocytes obtained fr om 14 females, 101 were injected with the husbands' testicular sperm c ells, Total. fertilization failure was observed in three cases, Of 39 oocytes fertilized, 38 cleaved. The fertilization and cleavage rates w ere 38.6 and 97.4% respectively, The pregnancy rate was 20.7% per init iated cycle, In the group from whom spermatozoa were obtainable, the p regnancy rate was 42.9% per initiated cycle and 54.5% per embryo trans fer A total of six pregnancies were achieved, of which two were twins and four were singletons, One singleton pregnancy resulted in abortion in the first trimester. There was no statistical difference concernin g the serum follicle stimulating hormone concentration, testicular vol ume and biopsy results in groups in which spermatozoa were obtainable or not. In conclusion, although the association of TESE with ICSI obta ined pregnancies for some patients with non-obstructive azoospermia, f urther studies are needed to determine the inclusion criteria for succ essful TESE.