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Abstract

Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men 
Palermo,Gianpiero D.; Schlegel,Peter N.; Hariprashad,June J.; Ergun,Berrin; Mielnik,Anna; Zaninovic,Nikica; Veeck,Lucinda L.; Rosenwaks,Zev R.
Human Reproduction 14(3): 741-748
Publication date: 1999


The evident ability of the intracytoplasmic sperm injection(ICSI) procedure to achieve high fertilization and pregnancyrates regardless of semen characteristics has induced its applicationwith spermatozoa surgically retrieved from azoospermic men.Here, ICSI outcome was analysed in 308 cases according to thecause of azoospermia; four additional cycles were with casesof necrozoospermia. All couples were genetically counselledand appropriately screened. Spermatozoa were retrieved by microsurgicalepididymal aspiration or from testicular biopsies. Epididymalobstructions were considered congenital (n = 138) or acquired(n = 103), based on the aetiology. Testicular sperm cases wereassessed according to the presence (n = 14) or absence (n =53) of reproductive tract obstruction. The fertilization rateusing fresh or cryopreserved epididymal spermatozoa was 72.4%of 911 eggs for acquired obstructions, and 73.1% of 1524 eggsfor congenital cases; with clinical pregnancy rates of 48.5%(50/103) and 61.6% (85/138) respectively. Spermatozoa from testicularbiopsies fertilized 57.0% of 533 eggs in non-obstructive casescompared to 80.5% of 118 eggs (P = 0.0001) in obstructive azoospermia.The clinical pregnancy rate was 49.1% (26/53) for non-obstructivecases and 57.1% (8/14) for testicular spermatozoa obtained inobstructive azoospermia, including three established with frozen-thawedtesticular spermatozoa. In cases of obstructive azoospermia,fertilization and pregnancy rates with epididymal spermatozoawere higher than those achieved using spermatozoa obtained fromthe testes of men with non-obstructive azoospermia.