PREGNANCIES ACHIEVED WITH TESTICULAR AND EJACULATED SPERMATOZOA IN COMBINATION WITH INTRACYTOPLASMIC SPERM INJECTION IN MEN WITH TOTALLY ORINITIALLY IMMOTILE SPERMATOZOA IN THE EJACULATE

The efficacy of intracytoplasmic sperm injection (ICSI) employing test icular and ejaculated spermatozoa was assessed in 24 couples with tota lly or initially immotile spermatozoa, No criteria were employed in se lecting which patients would be treated with testicular or ejaculated spermatozoa, The men were chosen at random, Testicular spermatozoa obt ained by testicular sperm extraction were used in 14 and ejaculated sp ermatozoa were used in 10 of these couples, In all cases, asthenozoosp ermia was total in their basal semen sample, In 12 male partners, sper matozoa were totally immotile before and after Percoll gradient fracti onation (totally immotile), In the remaining 12 men, spermatozoa initi ally showed a total absence of motility; however, some of the spermato zoa had showed very poor motility (0.1%) after Percoll gradient fracti onation and a 1.5-2.0 h incubation period (initially immotile), Of the se 24 total asthenozoospermic males, 14 also had total teratozoospermi a, The fertilization and cleavage rates in the testicular and ejaculat ed sperm groups were 53.5 and 96.3 and 54.5 and 94.4% respectively, On e cycle resulted in complete fertilization failure, and in 23 embryo t ransfer cycles a total of 10 pregnancies were obtained (41.6%), Eight pregnancies were achieved in the testicular sperm group, while only tw o pregnancies were obtained in the ejaculated sperm group, Four pregna ncies, two from the ejaculated sperm group and two from the testicular sperm group, resulted in clinical abortions in the first trimester, O f the remaining six pregnancies, two have already resulted in healthy births and four pregnancies are now in the second or third trimester i n the testicular sperm group, Using testicular spermatozoa in combinat ion with ICSI can be an alternative mode of treatment in cases with to tally or initially immotile spermatozoa in the ejaculate, Very low pre gnancy rates have been obtained and no ongoing pregnancy has been achi eved using ejaculated spermatozoa in these cases.