We report the use of percutaneous epididymal sperm aspiration as a sim
pler and more acceptable alternative to microscopic epididymal sperm a
spiration for patients with obstructive azoospermia in whom bypass sur
gery is not feasible or has not been successful. Some contamination of
the aspirate with blood is inevitable, but with careful sperm prepara
tion techniques this can be reduced substantially in the final aliquot
used for assisted conception. Spermatozoa with active forward progres
sion may be used for gamete intra-Fallopian transfer treatment, but wh
en this capacity is absent intracytoplasmic sperm injection is recomme
nded. Three pregnancies were obtained in seven couples and a set of tw
ins has been delivered.