Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa

A comprehensive study is presented of a series of 124 infertilemen undergoing testicular sperm retrieval for intracytoplasmicsperm injection (ICSI). In this study we correlated the histologicalchanges observed in the testicular tissue with the results ofthe wet preparation and the outcome after ICSI using testicularspermatozoa. In all patients with normal spermatogenesis andhypospermatogenesis spermatozoa were recovered from the wetpreparation. The sperm recovery rate was 84% in patients withincomplete germ-cell aplasia and maturation arrest, while inpatients with complete germ-cell aplasia or maturation arrestthis figure was 76%. In these patients more specimens were sampledand fewer spermatozoa were recovered. Since no spermatozoa wererecovered in only 10 patients, ICSI with testicular sperm wasperformed in the remaining 114 couples (91.9%). The normal fertilizationrate was 57.8%. The fertilization rate was significantly lowerin couples among whom the husband showed germ-cell aplasia andmaturation arrest. Overall, 55.2% of normally fertilized oocytesdeveloped into embryos showing 50% of anucleate fragments. Therewere no major differences between the different histologicalcategories in terms of embryonic development in vitro. The overallpregnancy rates per testicular sperm extraction (TESE) procedure,per ICSI procedure and per transfer were respectively 36.3,39.5 and 43.7%. The overall implantation rate per embryo (sacs/embryosreplaced) was 20.3%. A lower implantation rate was observedin couples among whom the husband had maturation arrest (notstatistically significant). The above data show that testicularbiopsies may have an important therapeutic role in the managementof infertility in azoospermic patients.