PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION AND INTRACYTOPLASMIC SPERM INJECTION IN THE MANAGEMENT OF INFERTILITY DUE TO OBSTRUCTIVE AZOOSPERMIA

Objective: To evaluate the recovery rate of spermatozoa from the epidi dymis using a percutaneous aspiration technique and to examine the fer tilization rate after intracytoplasmic sperm injection. Design: Prospe ctive observational study. Setting: Private infertility clinic, London . Subjects: Twenty patients with obstructive azoospermia who each had an attempt at IVF. The sperm used for intracytoplasmic sperm injection was retrieved by percutaneous epididymal sperm aspiration in 16 patie nts. In one patient, microepididymal sperm aspiration was performed in addition because the quality of the sperm obtained by percutaneous ep ididymal sperm aspiration was not considered suitable for microinjecti on. In the remaining three patients, neither percutaneous epididymal s perm aspiration nor microepididymal sperm aspiration resulted in the r ecovery of sperm, which was obtained by testicular biopsy in one of th em. Intervention: Assisted fertilization with intracytoplasmic sperm i njection. Main Outcome Measures: Normal fertilization and pregnancy ra tes. Results: A total of 179 eggs were collected and 157 subsequently were microinjected. Normal fertilization occurred in 22 oocytes (14%) and the total number of embryos cleaved was 30. Twelve patients underw ent ET in which three conceived (pregnancy rate 25% per transfer). The implantation rate was 10% and failed fertilization occurred in four c ycles. Conclusion: Percutaneous epididymal sperm aspiration can be use d successfully to recover sperm in men with obstructive azoospermia fo r use in assisted fertilization IVF cycles. The technique is simple, e ffective, and less traumatic compared with an open microsurgical opera tion.