Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men

The evident ability of the intracytoplasmic sperm injection (ICSI) procedur e to achieve high fertilization and pregnancy rates regardless of semen cha racteristics has induced its application with spermatozoa surgically retrie ved from azoospermic men. Here, ICSI outcome was analysed in 308 cases acco rding to the cause of azoospermia; four additional cycles were with cases o f necrozoospermia, All couples were genetically counselled and appropriatel y screened, Spermatozoa were retrieved by microsurgical epididymal aspirati on or from testicular biopsies. Epididymal obstructions were considered con genital (n = 138) or acquired (n = 103), based on the aetiology, Testicular sperm cases were assessed according to the presence (n = 14) or absence (n = 53) of reproductive tract obstruction. The fertilization rate using fres h or cryopreserved epididymal spermatozoa was 72.4% of 911 eggs for acquire d obstructions, and 73.1% of 1524 eggs for congenital cases; with clinical pregnancy rates of 48.5% (50/103) and 61.6% (85/138) respectively. Spermato zoa from testicular biopsies fertilized 57.0% of 533 eggs in non-obstructiv e cases compared to 80.5% of 118 eggs (P = 0.0001) in obstructive azoosperm ia, The clinical pregnancy rate was 49.1% (26/53) for non-obstructive cases and 57.1% (8/14) for testicular spermatozoa obtained in obstructive azoosp ermia, including three established with frozen-thawed testicular spermatozo a. In cases of obstructive azoospermia, fertilization and pregnancy rates w ith epididymal spermatozoa were higher than those achieved using spermatozo a obtained from the testes of men with non-obstructive azoospermia.