SUCCESSFUL SPERM RETRIEVAL BY PERCUTANEOUS EPIDIDYMAL AND TESTICULAR SPERM ASPIRATION

Purpose: We evaluated the safety and efficacy of percutaneous sperm as piration from the epididymis or testicle as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest spe rm for use in intracytoplasmic sperm injection. Materials and Methods: We present our experience with 69 sperm aspiration procedures in men considered to have nonreconstructible obstructive azoospermia. This sh ort outpatient procedure was performed using a butterfly needle with t he patient under intravenous sedation and local anesthesia. Results: O f the 32 diagnostic aspirations 20 demonstrated mature and motile sper m, 9 maturation arrest and 3 germ cell aplasia. In 35 of 37 therapeuti c sperm aspirations (95%) adequate samples of sperm after processing ( mean of 5.4 million) were obtained. Of 24 epididymal aspirations 13 (5 4%) had sufficient residual sperm for cryopreservation of 1 to 5 vials (mean 2.5) containing an average of 170,000 sperm per vial. In the 32 intracytoplasmic sperm injection cycles 221 of 392 eggs (56.3%) ferti lized (2PN) and 6 resulted in ongoing pregnancies (21.4% per transfer) . There have been no acute or chronic complications in this patient po pulation. Ten men underwent a second successful aspiration procedure f or intracytoplasmic sperm injection and 3 underwent a third aspiration without added difficulty. Conclusions: Percutaneous epididymal or tes tis sperm aspiration is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididyma l sperm aspiration, which is more invasive, costly and technically dif ficult.