Diagnostic epididymal and testicular sperm recovery and genetic aspects inazoospermic men

Various procedures for sperm recovery in azoospermic men have been describe d, from open testicular biopsy to simple needle aspiration from the epididy mis and the testis, Fifty-one obstructive and 86 non-obstructive azoospermi c men were treated to compare the recovery of spermatozoa obtained by percu taneous aspiration from the epididymis (PESA) and aspiration/extraction fro m the testis (TESA, TESE) with histopathology, If TESA failed, the work up proceeded with TESE. All patients were karyotyped, Spermatozoa were recover ed by PESA or TESA in all obstructive men (51/51 patients), In 22 out of 86 patients with non-obstructive azoospermia, testicular spermatozoa could be successfully recovered by TESA. In five additional patients TESE was succe ssful in recovering spermatozoa where TESA had failed. In 43 patients, neit her TESA nor TESE was successful. Sixteen patients chose not to proceed wit h TESE. Seven out of 86 patients had an abnormal karyotype in the non-obstr uctive group (8%), none in the obstructive group. In the non-obstructive pa tient group testicular histopathology showed hypospermatogenesis, incomplet e maturation arrest and germ cell aplasia with focal spermatogenesis in cas es where spermatozoa were recovered and complete germ cell aplasia, complet e maturation arrest and fibrosis in cases where no spermatozoa were found. Spermatozoa were recovered by PESA or TESA from all patients with obstructi ve azoospermia and from similar to 40% of patients with non-obstructive azo ospermia by TESA or TESE, Retrieval of viable spermatozoa in the infertilit y work-up was highly predictable for sperm recovery in subsequent ICSI cycl es. TESA performed under local anaesthesia seems almost as effective as mor e invasive procedures in recovering testicular spermatozoa, both in obstruc tive and non-obstructive azoospermic men.