PERCUTANEOUS TESTICULAR SPERM ASPIRATION - A CONVENIENT AND EFFECTIVEOFFICE PROCEDURE TO RETRIEVE SPERM FOR IN-VITRO FERTILIZATION WITH INTRACYTOPLASMIC SPERM INJECTION

Purpose: After intracytoplasmic sperm injection was established to fac ilitate in vitro fertilization in men with the most severe semen abnor malities, the use of testicular sperm to achieve conception became fea sible. We investigated the use of a method of percutaneous needle aspi ration previously used for diagnostic purposes to obtain testicular sp erm for intracytoplasmic sperm injection. Materials and Methods: A met hod of percutaneous aspiration of sperm was developed to facilitate in tracytoplasmic sperm injection. A total of 69 testicular aspirations w ere performed for diagnostic purposes and 179 to obtain sperm on the d ay of egg retrieval for couples undergoing in vitro fertilization with intracytoplasmic sperm injection. The procedures were performed in an outpatient facility. Most patients received intravenous sedation and a few received only local anesthesia. Results: Sperm adequate for intr acytoplasmic sperm injection were obtained in all men with obstructive azoospermia, including those with significant testicular atrophy and those with anejaculation or necrospermia. Adequate numbers of sperm fo r intracytoplasmic sperm injection were retrieved less reliably in men with nonobstructive azoospermia. The number of sperm correlated posit ively with testicular size. Morbidity and discomfort were nonexistent. Sperm were obtained from 43 of 69 men undergoing diagnostic and 170 o f 179 men undergoing therapeutic aspiration. Sperm motility ranged fro m 0 to 20% and viability from 55 to 85%. Conclusions: Percutaneous tes ticular sperm aspiration is a cost-effective method to retrieve! sperm for intracytoplasmic sperm injection in select men with obstructive a zoospermia, anejaculation and necrospermia, and same with nonobstructi ve azoospermia.