IN-VITRO FERTILIZATION TREATMENT FOR SEVERE MALE FACTOR - A COMPARATIVE-STUDY OF INTRACYTOPLASMIC SPERM INJECTION WITH TESTICULAR SPERM EXTRACTION AND WITH SPERMATOZOA FROM EJACULATE

Purpose: Our purpose was to evaluate whether the source of spermatozoa influences the results of intracytoplasmic sperm injection (ICSI) tre atment in couples with severe malefactor infertility. Methods: A retro spective analysis of 40 cases of ICSI with testicular-retrieved sperma tozoa, matched with 40 cases of ICSI with ejaculated spermatozoa, was performed. We included only couples with normoovulatory females younge r than 37 years who were matched according to the day of ovum pickup w ith the patients in the study group. Results: Eighty cycles were analy zed: 40 cycles using testicular spermatozoa and 40 cycles using ejacul ated spermatozoa.. In 32 (80%) of the 40 ICSI transcutaneous needle as piration cycles, we obtained enough spermatozoa to inject all the matu re oocytes retrieved. In eight (20%) cases there were not enough sperm atozoa to inject all the oocytes. Only 76 (54%) of 141 available oocyt es were injected in these eight patients. The oocyte fertilization rat es were 42% for the study group and 55.5% for the controls (P < 0.005) . Thirty-six (90%) patients in the group with nonobstructive a zoosper mia (NOA) and 37 (92.5%) patients in the oligoteratoasthenospermia (OT A) group had embryos for replacement. The mean cleavage rates per cycl e (96% with tasticular and 93% with ejaculated spermatozoa), the mean number of embryos per transfer (3.72 +/- 1.6 in the NOA group and 4.24 +/- 1.5 in the OTA group), the embryo quality (cumulative embryo scor ing = 34.03 +/- 22.62 in the testicular sperm group and 36.08 +/- 19.2 8 in the ejaculated sperm group), and the clinical pregnancy rates (22 .5% in the NOA patients and 20% in the ejaculate group) were not signi ficantly different between groups. Conclusions: High fertilization, cl eavage, and pregnancy rates can be achieved with intracytoplasmic test icular sperm injection from patients with NOA, reaching levels compara ble with those of ICSI using ejaculated spermatozoa..