TESTICULAR SPERM EXTRACTION AND INTRACYTOPLASMIC SPERM INJECTION - A CHANCE OF FERTILITY IN NONOBSTRUCTIVE AZOOSPERMIA

Purpose: We evaluate the efficacy of testicular sperm extraction and r esults of intracytoplasmic sperm injection in cases of nonobstructive azoospermia. In addition, we define predictive parameters for successf ul testicular sperm extraction in these patients. Materials and Method s: A total of 154 patients with nonobstructive azoospermia underwent m ultiple testicular biopsies to obtain testicular spermatozoa and for h istopathological diagnosis. Results of testicular sperm extraction wer e related to suspected etiology of azoospermia, patient age, maximal t esticular volume, serum follicle-stimulating hormone and histopatholog y. When testicular sperm extraction was successful, intracytoplasmic s perm injection was performed. Results: Spermatozoa were obtained from 63 patients (41%). No potential predictive parameters precluded succes sful testicular sperm retrieval. Fertilization was achieved in 74 of 7 6 intracytoplasmic sperm injection cycles. Normal 2 pronuclear fertili zation was observed in 55% of the intact oocytes after microinjection. Clinical pregnancies were achieved in 21 cases for a pregnancy rate o f 28% per started cycle. There were 4 miscarriages and 11 live births from 9 deliveries. In addition, a set of twins died after birth becaus e of prematurity. Seven pregnancies were ongoing. Conclusions: Men wit h nonobstructive azoospermia may have areas of preserved spermatogenes is in the testicles, and these spermatozoa can be retrieved for intrac ytoplasmic sperm injection. Although some clinical and histopathologic al parameters are associated with significantly different sperm recove ry rates, it is not possible to predict with certainty the outcome of testicular sperm extraction in an individual patient. If testicular sp erm extraction is successful, intracytoplasmic sperm injection offers the chance of pregnancy to these otherwise intractably infertile coupl es.