EPIDIDYMAL SPERM ASPIRATION WITH ASSISTED REPRODUCTIVE TECHNIQUES - DIFFERENCE BETWEEN CONGENITAL AND ACQUIRED OBSTRUCTIVE AZOOSPERMIA

From July 1992 to May 1994, 31 cases of obstructive azoospermia-induce d infertility underwent 35 epididymal sperm aspiration procedures and assisted reproductive techniques. These included in-vitro fertilizatio n zygote intra-Fallopian transfer (ZIFT), subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) with embryo transfer or t ubal embryo transfer. The motile spermatozoa were retrieved using a ga uge 24 Medicut cannula and flush medium. Total oocyte fertilization ra te was 23.4% and the clinical pregnancy rate was 12.5% (four out of 32 treatment cycles). Congenital absence of the vas deferens was found i n 16 cases (51.6%) and secondary genital duct obstruction was present in 15 cases (48.4%). In all, 29 aspirations were retrieved from the ca put of the epididymis and six from the epididymal beds or tail. The fe rtilization rate for the caput spermatozoa was much less than that for other areas of the epididymis (P < 0.05). Though there were no predic table differences in fertilization rates between the congenital and ac quired groups, by using epididymal spermatozoa for assisted reproducti on, the congenital group seemed to have a stronger tendency to achieve pregnancy (20 versus 5.9%).