TREATMENT OUTCOME FOLLOWING INTRACYTOPLASMIC INJECTION OF SPERM RETRIEVED FROM EJACULATE, EPIDIDYMIS, OR TESTIS OF INFERTILE MEN

Introduction of intracytoplasmic sperm injection (ICSI) offered an effective therapy for males with infertility including those with azoospermia. The novel techniques for sperm retrieval from the epididymis (percutaneous epididymal sperm aspiration [PESA]) and testis (testicular sperm aspiration [TESE]) have been successfully combined with ICSI. This is the first preliminary report on ICSI with ejaculated sperm (80 cycles), PESA/ICSI (40 cycles), and TESE/ICSI (40 cycles) in Iran. The study population comprised 160 consecutive young males with primary infertility admitted to Research and Clinical Center for Infertility in Yazd, Iran. Eighty subjects (mean ± SD of age: 34.0 ± 4.4 years) could produce ejaculates while in the rest who had obstructive azoospermia, the sperm was obtained by PESA or TESE. All wives were treated for ovarian stimulation and oocytes were retrieved 34 to 36 hours after human chorionic gonadotropin (HCG) injections. Sperm parameters of count, motility, and morphology were analyzed and ICSI was performed 2 to 3 hours after the incubation of the processed sperm. The rate of fertilization and embryo development and transfer were subsequently evaluated. The results showed that the fertilization rate for the groups whose sperms had been obtained by ejaculation, PESA, and TESE was 72.1%, 73.6%, and 51.3%, respectively. The mean number of embryo transfers for the aforementioned groups was 3.0, 3.8, and 2.6, respectively. The parameters of sperm count and morphology were similar in the ejaculate and PESA groups. They were, however, lower in TESE samples (p < 0.01). The results confirm that PESA and TESE are very effective for obtaining adequate numbers of sperms to successfully treat male infertility including obstructive azoospermia.