Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia

Male genital tract obstructions may result from infections, previousinguinal and scrotal surgery (vasectomy) and congenital bilateral absenceof the vas deferens (CBAVD). Microsurgery can sometimes be successful intreating the obstruction. In other cases and in cases of failed surgicalintervention, the patient can be treated by microsurgical or percutaneousepididymal sperm aspiration (MESA, PESA) or testicular sperm extraction(TESE) and intracytoplasmic sperm injection (ICSI). We present the resultsof 39 ICSI procedures for obstructive azoospermia in 24 couples. Theaetiology of the obstruction was failed microsurgery in 11 patients, CBAVDin nine and genital infections in four. Sperm retrieval was accomplishedvia MESA in four cases, PESA in 18 cases and via TESE in 11 cases. TESE wasonly applied when PESA failed to produce enough spermatozoa forsimultaneous ICSI. In six patients, the ICSI procedure was performed withcryopreserved spermatozoa after an initial PESA procedure. Fertilizationoccurred in 47% of the metaphase II oocytes; embryo transfer was performedin 92% of procedures and resulted in a clinical pregnancy in 13/39procedures. Ongoing pregnancy was achieved in 10/39 procedures. Onepregnancy was terminated early after prenatal investigation showed acytogenetic abnormality (47,XX+18, Edwards syndrome). The other ninepregnancies resulted in the live birth of 10 children, without anycongenital abnormalities. Epididymal and testicular retrieved spermatozoawere successfully used for ICSI to treat obstructive azoospermia, andresulted in an ongoing pregnancy in 10 of 24 couples (41.6%) after 39 ICSIprocedures, a success rate of 25.6% per treatment cycle and of 27.7% perembryo transfer.