DELIVERY FOLLOWING INTRACYTOPLASMIC INJECTION OF MATURE SPERM CELLS RECOVERED BY TESTICULAR FINE-NEEDLE ASPIRATION IN A CASE OF HYPERGONADOTROPIC AZOOSPERMIA DUE TO MATURATION ARREST

This is the first reported delivery following intracytoplasmic sperm i njection (ICSI) of mature live testicular sperm cells collected in a c ase of hypergonadotrophic azoospermia with maturation arrest. The 30 y ear old couple presented with primary infertility of 11 years duration , the man being submitted in childhood to five orchidopexy operations for the treatment of cryptorchism, He had elevated serum follicle stim ulating hormone (FSH; 18.8 IU/l), an atrophic left testis and a normal sized right testis, the biopsy of which diagnosed maturation arrest a nd focal scarring, The couple refused donor insemination for religious reasons and the only option was an attempt at testicular sperm collec tion, Multiple testicular and epididymal fine needle aspirations were performed, using an aspiration handle loaded with 20 ml syringe and 21 -23 gauge butterfly needles. The mature spermatozoa recovered were use d to inseminate the oocytes by ICSI, Prior to this procedure, the pati ent's wife underwent ovulation induction using a long protocol of mid- luteal gonadotrophin-releasing hormone analogue/human menopausal gonad otrophin (GnRHa/HMG). At oocyte retrieval, ten oocytes were recovered. Eight live sperm cells were recovered from the aspirates of the right testis, Following ICSI into four metaphase II and two metaphase I ooc ytes, one mature oocyte was fertilized, cleaved and was transferred to the uterus 48 h after oocyte retrieval, The patient conceived and del ivered a 3300 g boy at term, In conclusion, our results demonstrate th at this novel approach should be considered in cases with hypergonadot rophic azoospermia due to testicular failure, Further experience is ne eded to establish the exact criteria for its use.