SURGICAL SPERM RETRIEVAL AND INTRACYTOPLASMIC SPERM INJECTION AS TREATMENT OF OBSTRUCTIVE AZOOSPERMIA

Male genital tract obstructions may result from infections, previous i nguinal and scrotal surgery (vasectomy) and congenital bilateral absen ce of the vas deferens (CBAVD), Microsurgery can sometimes be successf ul in treating the obstruction. In other cases and in cases of failed surgical intervention, the patient can be treated by microsurgical or percutaneous epididymal sperm aspiration (MESA, PESA) or testicular sp erm extraction (TESE) and intracytoplasmic sperm injection (ICSI), We present the results of 39 ICSI procedures for obstructive azoospermia in 24 couples. The aetiology of the obstruction was failed microsurger y in 11 patients, CBAVD in nine and genital infections in four. Sperm retrieval was accomplished via MESA in four cases, PESA in 18 cases an d via TESE in 11 cases, TESE was only applied when PESA failed to prod uce enough spermatozoa for simultaneous ICSI, In six patients, the ICS I procedure was performed with cryopreserved spermatozoa after an init ial PESA procedure. Fertilization occurred in 47% of the metaphase IT oocytes; embryo transfer was performed in 92% of procedures and result ed in a clinical pregnancy in 13/39 procedures. Ongoing pregnancy was achieved in 10/39 procedures. One pregnancy was terminated early after prenatal investigation showed a cytogenetic abnormality (47,XX+18, Ed wards syndrome). The other nine pregnancies resulted in the live birth of 10 children, without any congenital abnormalities, Epididymal and testicular retrieved spermatozoa were successfully used for ICSI to tr eat obstructive azoospermia, and resulted in an ongoing pregnancy in 1 0 of 24 couples (41.6%) after 39 ICSI procedures, a success rate of 25 .6% per treatment cycle and of 27.7% per embryo transfer.