Percutaneous epididymal sperm aspiration versus microsurgical epididymal sperm aspiration for irreparable obstructive azoospermia - Experience with 100 cases

Purpose: This study investigated the sperm retrieval success rates, fertili zation rates, pregnancy rates, and complications of percutaneous epididymal sperm aspiration (PESA) and microsurgical epididymal sperm aspiration (MES A) in cases of irreparable obstructive azoospermia. Methods: During a period of 36 months, 100 men with irreparable obstructive azoospermia underwent 109 cycles of sperm retrieval procedures and intracy toplasmic sperm injection (ICSI). We routinely performed PESA first in each retrieval cycle; MESA and/or testicular sperm extraction (TESE) were perfo rmed if PESA failed. The sperm retrieval success rates, mean fertilization rates, and pregnancy rates of PESA and MESA were evaluated. Results: PESA was performed in all 109 retrieval cycles with a successful s perm retrieval rate of 61%, When PESA failed to retrieve a sufficient numbe r of viable sperm, MESA was subsequently performed with a sperm retrieval r ate of 93%;. Three cases, which had failed retrieval with both the PESA. an d MESA procedures, received TESE successfully. The rates of fertilization a nd pregnancy were 56% and 39% in the 66 PESA-ICSI cycles, respectively, and 47% and 45% in the 40 MESA-ICSI cycles. No significant differences were fo und in fertilization rates or pregnancy rates among the various sperm retri eval methods and obstruction etiologies. The overall mean fertilization rat e and pregnancy rate were 51% and 41%, respectively. Conclusion: Both PESA and MESA can be used successfully to obtain sufficien t sperm for ICSI. PESA cannot replace MESA in some cases as some epididymal pathologies prevent its success. The results of this study indicate that P ESA should be the treatment of choice for patients with ductal obstruction distal to the epididymis, owing to its higher initial success rate. In cont rast, patients with irreparable epididymal obstruction might achieve better success rates with MESA.