Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine-needle aspiration mapping in patients with nonobstructive azoospermia

Objective: To evaluate intracytoplasmic sperm injection (ICSI) outcomes in a cohort of men with nonobstructive azoospermia who underwent prior fine-ne edle aspiration (FNA) "maps" to localize Sperm and guide testis sperm extra ction (TESE). Design: Retrospective clinical study. Setting: University-based infertility practice. Patient(s): A consecutive cohort of 19 infertile, azoospermic men. Intervention(s): Couples underwent IVF-ET in which TESE procedures were inf ormed and directed by prior FNA maps of the testis. Main Outcome Measure(s): Sperm retrieval and pregnancy rates. Result(s): In 21 IVF-ET and ICSI cycles, sufficient sperm for all oocytes w ere retrieved in 20 TESE attempts (95%). A mean of 3.1 biopsies per patient were required, with an average size of 72 mg. Mean operative Lime for the TESE procedure was 88 minutes. Overall, the two-pronuclear fertilization ra te was 66%; ongoing clinical pregnancies were obtained in 10 of 21 initiate d cycles (48%). Conclusion(s): In an effort to reduce IVF-ET cancellation rates in cases of nonobstructive azoospermia, diagnostic testis FNA can define those patient s who art: good candidates far TESE. It also directs sperm retrieval and mi nimizes tissue removal from nonobstructed testes. (Fertil Steril(R) 1999;71 :552-7. (C) 1999 by American Society for Reproductive Medicine.)