HIGH FERTILIZATION AND PREGNANCY RATE AFTER INTRACYTOPLASMIC SPERM INJECTION WITH SPERMATOZOA OBTAINED FROM TESTICLE BIOPSY

In cases requiring microsurgical epididymal sperm aspiration (MESA) fo r congenital absence of the vas deferens (CAVD) or irreparable obstruc tive azoospermia, often no spermatozoa can be retrieved from the epidi dymis, or there may even be no epididymis present. We wished to see wh ether testicular biopsy with testicular sperm extraction (TESE) in suc h cases could yield spermatozoa that would result in successful fertil ization and pregnancy (despite the absence of epididymal spermatozoa) using intracytoplasmic sperm injection (ICSI). In the same setting dur ing the same 2-week period, 28 patients with CAVD or irreparable obstr uction were treated; 16 consecutive fresh MESA-ICSI cycles and 12 cycl es which required testicular biopsy with testicular sperm extraction ( TESE-ICSI) were performed. Normal two-pronuclear fertilization rates w ere similar in both groups: 45% for epididymal spermatozoa and 46% for testicular biopsy-extracted spermatozoa. Cleavage rates were also sim ilar (68% for epididymal and 65% for testicular spermatozoa). The ongo ing pregnancy rates in this series were 50 and 43% respectively. We co nclude that epididymal spermatozoa and testicular spermatozoa yield si milar fertilization, cleavage and ongoing pregnancy rates using ICSI. When epididymal spermatozoa cannot be retrieved, a testicular biopsy c an be performed and the few barely motile spermatozoa thus obtained ca n be used for ICSI. It appears that all cases of obstructive azoosperm ia can now be successfully treated.