EPIDIDYMAL AND TESTICULAR SPERM FOR INTRACYTOPLASMIC SPERM INJECTION IN THE TREATMENT OF OBSTRUCTIVE AZOOSPERMIA

Background. The possibility of treating male infertility because of ob structive azoospermia has been poor, but intracytoplasmic sperm inject ion (ICSI) has given this type of infertility sufferer a new option. M aterial and methods. In this study 13 couples with obstructive azoospe rmia were treated in a total of 19 stimulated IVF cycles. The men were between 27 and 45 (mean 33) years of age. Their partners, 24-39 (mean 31) years of age were treated according to routine IVF procedures, i. e. down regulation with buserelin followed by hyperstimulation with ur ofollitropin. Fertilization was obtained by ICSI. Two embryos were tra nsferred on day two after the ovum pick up. Sperm were retrieved throu gh microsurgical epididymal aspiration (MESA) in four cycles, percutan eous epididymal sperm aspiration (PESA) in three cycles and through te sticular sperm extraction (TESE) in 12 cycles. Results. The overall fe rtilization rate was 68%, with a cleavage rate of 82%.The fertilizatio n rate was equal (68%) with epididymal and testicular sperm and the cl eavage rate was 87% and 80%, respectively Embryos were obtained for em bryo transfer (ET) in all cases and five pregnancies (one twin pregnan cy) were established (26% per ET), three using epididmal sperm and two using testicular sperm. Conclusion. Infertility due to obstructive az oospermia can successfully be treated with epididymal sperm and ICSI. When epididymal sperm cannot be found sperm extracted from a testicula r biopsy can be used. PESA and TESE are quicker and easier alternative s to MESA and can be performed on an outpatient basis with local anest hesia.