MICROPUNCTURE RETRIEVAL OF EPIDIDYMAL SPERM WITH IN-VITRO FERTILIZATION - IMPORTANCE OF IN-VITRO MICROMANIPULATION TECHNIQUES

Objectives. To evaluate the importance of in vitro micromanipulation t echniques, specifically intracytoplasmic sperm injection (ICSI), for t he fertility treatment of men with congenital absence of the vas defer ens (CAV) or other unreconstructable male reproductive tract obstructi on. Methods. Results using ICSI during in vitro fertilization (IVF) we re compared to previously published results of IVF alone and IVF with other micromanipulation techniques at the same infertility center. Mai n outcome parameters evaluated were: fertilization rate per oocyte, cl inical pregnancy rate, and ongoing pregnancies and deliveries. Results . IVF with ICSI yielded a fertilization rate per oocyte of 140 of 312 (45%) and a clinical pregnancy rate of 14 of 27 (52%) per cycle of spe rm and egg retrieval, Ongoing pregnancies or deliveries have occurred for 13 of 27 (48%) cycles with ICSI. These results were better than ou r previously published results of IVF alone or in conjunction with the micromanipulation techniques of subzonal insertion (SuZI) or partial zona dissection (PZD) that yielded a 119 of 631 (19%; P < 0.0001) fert ilization rate, clinical pregnancy rate of 14 of 51 (27%; P < 0.001), and ongoing pregnancy or delivery for 12 of 51 cycles (24%; P < 0.001) . Conclusions. Epididymal sperm retrieval should be performed only whe n micromanipulation is available in conjunction with IVF to maximize c hances of fertilization and subsequent pregnancies, The use of ICSI fo r epididymal sperm appears to maximize chances of pregnancy for couple s with surgically unreconstructable obstructive male infertility.