FACTORS INFLUENCING THE OUTCOME OF IN-VITRO FERTILIZATION WITH PERCUTANEOUS ASPIRATED EPIDIDYMAL SPERMATOZOA AND INTRACYTOPLASMIC SPERM INJECTION IN AZOOSPERMIC MEN

In-vitro fertilization (IVF) by intracytoplasmic sperm injection (ICSI ) with spermatozoa retrieved by percutaneous epididymal sperm aspirati on (PESA) is a novel, simple and effective treatment for azoospermic m en, In all, 38 azoospermic men had an IVF/PESA/ICSI cycle. A total of 42 cycles were performed. The aetiology of azoospermia was classified as failed vasectomy reversal (12 patients/16 cycles), inflammatory obs truction (five patients/five cycles), partial testicular failure (five patients/five cycles) and bilateral congenital absence of vas (16 pat ients/16 cycles), Adequate sperm preparations for ICSI were obtained f rom 38 of the 42 treatment cycles (90%). The mean fertilization rate w as 32.7%, and fertilization occurred in 35 cycles (92.0%), Embryo tran sfer was performed in 13 out of 14 cycles (93%) in men with a failed v asectomy reversal, four out of five cycles in men with an inflammatory obstruction (80%), four out of four cycles in men with a partial test icular failure (100%), and 14 out of 15 cycles in men with a bilateral congenital absence of vas (93%), The overall pregnancy rate per two o r three embryos transferred was 28.6 and 26.3% per treatment cycle res pectively. The sperm parameters of the final pooled sperm aspirate pre parations varied widely among the four aetiological groups, These para meters were of no value in predicting the fertilization or pregnancy r ates (P > 0.05), and neither was the embryo cleavage rate.