NORMAL PREGNANCIES RESULTING FROM TESTICULAR SPERM EXTRACTION AND INTRACYTOPLASMIC SPERM INJECTION FOR AZOOSPERMIA DUE TO MATURATION ARREST

Objective: To see whether testicular sperm extraction could be used to perform intracytoplasmic sperm injection (ICSI) for men with nonobstr uctive azoospermia caused by maturation arrest. Design: Uncontrolled p rospective trial of an attempt to find occasional elongated spermatids or spermatozoa in testes of azoospermic patients with maturation arre st and to use these haploid cells for ICSI. Setting: European universi ty-based center for reproductive medicine and private American communi ty hospital. Patients: Thirty-eight azoospermic males without obstruct ion and with biopsy-documented maturation arrest, seven of whom electe d, with their wives, to undergo scrotal exploration and testicular spe rm extraction with ICSI in an attempt to become pregnant. Intervention s: Histologic evaluation of spermatid development in 38 patients with azoospermic maturation arrest. Testicular sperm extraction with ICSI i n seven random volunteers from this group. Main Outcome Measures: Pres ence or absence of mature spermatids in the testis biopsy specimen of patients with azoospermic maturation arrest. Fertilization, cleavage, and pregnancy after testicular sperm extraction and ICSI in patients w ith azoospermic maturation arrest. Results: All seven patients with az oospermic maturation arrest had occasional sperm found with testicular sperm extraction. Five had sufficient numbers (between 6 and 30) for ICSI, and those five had ETs. In four, the partners became pregnant. I n all 38 patients examined, the maturation defect was in meiosis rathe r than in spermiogenesis. Conclusion: Nonobstructive azoospermia cause d by maturation arrest may be treated with testicular sperm extraction with ICSI apparently as successfully as Sertoli cell only.