Outcome of intracytoplasmic sperm injection in azoospermic patients: Stressing the liaison between the urologist and reproductive medicine specialist

Objectives. To analyze the outcome of intracytoplasmic sperm injection (ICS I) cycles in infertile couples in whom the main diagnosis of infertility wa s azoospermia of obstructive and nonobstructive origin. Methods. Eighty-three consecutive ICSI cycles were carried out with retriev ed testicular or epididymal spermatozoa, 60 cycles in 32 patients with obst ructive azoospermia and 23 cycles in 12 patients with nonobstructive azoosp ermia. Fifty-four testicular biopsies (testicular sperm extraction) and 18 epididymal aspirations (microepididymal sperm aspiration) were performed. Results. Motile spermatozoa were recovered in 65 cycles (90.3%). In another 3 (4.2%), nonmotile spermatozoa were retrieved. In 4 patients (5.5%), sper m could not be recovered. In 11 cycles, frozen sperm from a previous proced ure were used. A significantly lower fertilization rate (64% versus 73%, P = 0.02), clinical pregnancy rate (13% versus 47%, P <0.001), and good embry o quality rates (35% versus 56%, P = 0.009) were observed in patients with nonobstructive azoospermia. In patients with obstructive azoospermia, no si gnificant differences were observed when the outcome was analyzed on the ba sis of the sperm origin (ie, from testicular sperm extraction or microepidi dymal sperm aspiration). Conclusions. When combining testicular sperm extraction or microepididymal sperm aspiration with ICSI in patients with obstructive azoospermia, the re sults in terms of fertilization, implantation, and pregnancy rates were sim ilar to those found in patients with nonazoospermic obstruction who underwe nt ICSI with ejaculated sperm. Patients with nonobstructive azoospermia had lower fertilization, embryo quality, and pregnancy rates than did those wi th obstructive azoospermia, probably because of severe defects in spermatog enesis, leading to poor gamete quality. The urologist and reproductive endo crinologist now have an excellent therapeutic option to offer men with prev iously intractable infertility. UROLOGY 58: 69-75, 2001. (C) 2001, Elsevier Science Inc.