RESULTS IN THE UNITED-STATES WITH SPERM MICROASPIRATION RETRIEVAL TECHNIQUES AND ASSISTED REPRODUCTIVE TECHNOLOGIES

Improved methods of urological microsurgery and of various assisted re productive technologies have resulted in the ability to achieve pregna ncies with sperm aspirated microsurgically from men with bilateral con genital absence of the vasa deferentia or with ductal obstructions tha t cannot be surgically reconstructed. A survey was conducted of the re sults of such procedures performed in the United States during approxi mately 2 years. Female partner ovarian stimulation was initiated in 21 9 instances at 22 centers. Of the 219 procedures 23 (11%) were termina ted without attempting any form of gamete fertilization or inseminatio n of the wife for various reasons (no sperm or too few sperm retrieved , poor to absent sperm motility or poor quality eggs). The etiology of azoospermia in the 219 procedures was congenital absence of the vasa deferentia in 115 cases (52%), other congenital conditions in 15 (7%), failed vasectomy reversal in 37 (17%), infection in 4 (2%), other con ditions (mainly ejaculatory dysfunctions that did not respond to elect roejaculation and complex ductal obstructions) in 26 (12%) and not spe cified in 22 (10%). When only patient sperm was used pregnancy was ach ieved in 12 of 115 wives (10%) of those men who had congenital absence of the vasa deferentia and in 0 to 14% of the wives of men whose azoo spermia was caused by other conditions. Of the 219 menstrual cycles in which ovarian stimulation was initiated pregnancy occurred in 24 (11% ) with patient sperm and in 9 (4%) with donor sperm. Of these 33 pregn ancies a full-term, live delivery occurred in 17 (52%), while 8 (24%) were ongoing at the time of reporting, 2 (6%) miscarried, 3 (9%) were chemical pregnancies, 1 (3%) resulted in a stillborn child and the out come was unknown in 2 (6%). This new therapy offers only a modest chan ce of pregnancy. However, it affords men with azoospermia the opportun ity to achieve paternity with their own sperm when other therapies are not available or applicable.