Outcome of ICSI cycles using frozen-thawed surgically obtained spermatozoain poor responders to ovarian stimulation: cancellation or proceeding to ICSI?

Objective: To investigate the ICSI outcome of the patients who produced fou r follicles or less after ovarian stimulation using frozen-thawed surgicall y obtained spermatozoa. Study design: The patient cohort of this study was composed of a carefully selected group of 20 men suffering from obstructive and non-obstructive azoospermia and in whom spermatozoa had been seen in t heir harvested epididymal aspirates and testicular tissues and the cryopres erved specimens had been used for subsequent ICSI cycles. This group of men represent those in whom the female partners produced only four follicles o r less after ovarian stimulation. Results: For the cases of obstructive azo ospermia with MESA (n = 6) a total of nine cycles was carried out. Four cou ples went through one cycle, one couple underwent two cycles, one couple ac complished three cycles. Out of the nine cycles, seven went to embryo trans fer. No pregnancy occurred in the MESA-ICSI group of patients. The mean +/- S.D. number of oocytes per cycle was 2.556 +/- 1.236, the mean +/- S.D, nu mber of embryos per transfer was 1.444 +/- 1.014. Two couples did not have an embryo replacement because of absence of fertilisatian. The mean +/- S.D . number of gonadotropin ampoules was 53.88 +/- 37.30 and the mean +/- S.D. duration of ovarian stimulation was 13.38 +/- 4.534 days. For the cases of non-obstructive azoospermia with TESE (n = 14) a total of 16 cycles was ca rried out. Thirteen couples went through one cycle, one couple accomplished three cycles. Out of the 16 cycles, 11 cycles went to embryo transfer. One pregnancy occurred in;he TESE-ICSI group of patients, which produced live offspring. The mean +/- S.D. number of oocytes per cycle was 3.00 +/- 1.211 , the mean +/- S.D. number of embryos per transfer was 1.313 +/- 1.195. Fiv e couples did not have an embryo replacement, four of them because of absen ce of fertilisation and one because of abnormal fertilisation (3 PN). The m ean +/- S.D. number of gonadotropin ampoules was 81.77 +/- 53.40 and the me an +/- S.D. duration of ovarian stimulation was 16.71 +/- 3.667 days: Concl usion: In our opinion, these data show that it is possible to achieve satis factory fertilisation rates using frozen-thawed epididymal and testicular s permatozoa obtained from men with obstructive or non-obstructive azoospermi a, but the limiting factor in reaching the stage of embryo transfer is the poor ovarian response to stimulation induction. It therefore seems preferab le to cancel these cycles, in the hope that a better response might be obta ined in a subsequent cycle, avoiding in this way financial and emotional im plications. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.