INTRACYTOPLASMIC SPERM INJECTION (ICSI) WITH SPERMATOZOA FROM THE EPIDIDYMIDIS (MESA) AND THE TESTIS (TESE) - A RETROSPECTIVE ANALYSIS OF MORE THAN 500 TREATMENT CYCLES

We report on 510 treatment cycles of intracytoplasmic injection of spe rmatozoa (ICSI) up to the end of december 1997. The employed spermatoz oa were obtained either by microsurgical spermatozoa aspiration (MESA) or testicular spermatozoa extraction (TESE). All of the 59 husbands t hat underwent MESA suffered from obstructive azoospermia or ejaculator y disorders. Most of the husbands being scheduled for TESE suffered fr om testicular insufficiency, i.e. spermatogenic disorders. A total of 198 men underwent TESE, however, in 39 of them (19,7%) we failed to fi nd any spermatozoa - in spite of performing multilocular biopsies. Bec ause we also failed to retrieve any spermatozoa in one MESA-patient, 2 17 patients remained for treatment by ICSI. Since the beginning of 199 6 we abandoned the simultaneous performance of TESE/MESA and oocyte re trieval and introduced the injection of cryopreserved spermatozoa as r outine. Thus, in 409 treatment cycles cryopreserved and thawed spermat ozoa were used, and in 101 treatment cycles ''fresh'' spermatozoa. In 510 treatment cycles 473 embryotransfers were carried out (ET-rate: 92 .7%), and no differences were found in the results between MESA and TE SE, fresh and cryopreserved spermatozoa. The overall rate of clinical pregnancies was 25.8% per (single) embryotransfer, and again there wer e no differing results between MESA and TESE, fresh and cryopreserved spermatozoa. The same results were found for the rate of clinical abor tions, which was 13.2% on average. The pregnancy rate per patient (cum ulative pregnancy rate) presently is 55.7%. Because some patients are still scheduled for further treatment cycles, the cumulative pregnancy rate is likely to be higher in the end. We conclude from these result s that MESA/ICSI and TESE/ICSI are effective approaches in the treatme nt of ejaculatory azoospermia and that cryopreservation of spermatozoa does not negatively influence the outcome. Because cryopreservation o f spermatozoa has many additional advantages, it is recommended as rou tine in the performance of MESA/ICSI and TESE/ICSI.