Abstract
Objective: Our objective was to evaluate the recovery rate of spermatozoa from the epididymis using a percutaneous aspiration technique and to assess the fertilisation rate after intracytoplasmic sperm injection.
Materials and Methods: Fifty-four patients with azoospermia had a total of 59 cycles at IVF with intracytoplasmic sperm injection (ICSI). The cause of the azoospermia was failed vasectomy reversal in 23 cases, congenital absence of the vas in 22 cases, partial testicular failure in 5 cases, and retrograde ejaculation in 2 cases, while the remaining 2 patients had erectile disorders.
Results: A total of 741 oocytes was collected and 521 metaphase II oocytes were subsequently microinjected. Normal fertilisation occurred in 274 oocytes (52.6%), and of these, 234 cleaved (85.4%). In 54 cycles, embryo transfer of more than one embryo occurred (91.5%) and a total of 155 embryos was replaced. The pregnancy rate was 30.5% per cycle and 33.3% per embryo transfer. The implantation rate was 14.2%; failure of fertilisation occurred in two cycles, while in three other cycles the embryos did not cleave.
Conclusions: Percutaneous epididymal sperm aspiration can be used successfully to retrieve sperm in men with azoospermia due to obstructive, or nonobstructive, disorders. The technique is simple, cost-effective, and associated with fewer complications than an open microsurgical operation.
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References
Van Steirteghem AC, Nagy Z, Joris H, Liu J, Staessen C, Schmidt J,et al. High fertilisation and implantation rates after intracytoplamic sperm injection. Hum Reprod 1993;8:1061–1066
Tsirigotis M, Yang D, Redgment CJ, Nicholson N, Pelekanos M, Craft IL: Assisted fertilisation with intracytoplasmic sperm injection. Fertil Steril 1994;62:781–785
Silber S, Nagy Z, Liu J, Godoy H, Devroey P, Van Steirteghem AC: Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 1994;9:1705–1709
Temple-Smith PD, Southwick GJ, Yates CA, Trounson AO, Kretser DM: Human pregnancy by in-vitro fertilisation (IVF) using sperm aspirated from the epididymis J Vitro Fer Embryo Transfer 1985;2:119–122
Silber SJ, Asch RH: Epididymal surgery.In Infertility, Templeton AA, Drife JO, eds. London, Springer Verlag, 1992, pp 133–153
Ng SC, Bongso TA, Liow SL, Edirsinghe R, Tok V, Ratnam SS: Controversies in microinjection. J Assist Reprod Genet 1992;9:186–189
Fishel S, Timson J, Lisi F, Rinaldi L: Evaluation of 225 patients undergoing subzonal insemination for the procurement of fertilization in vitro. Fertil Steril 1992;57:840–849
Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey P: High fertilisation and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy. Hum Reprod 1995;10:148–152
Tsirigotis M, Bennett V, Hogewind G, Pelekanos M, Craft IL: Percutaneous epididymal sperm aspiration: Simplified sperm recovery for obstructive azoospermia. Hum Reprod 1994;9:169–170
Tsirigotis M, Boulos A, Hogewind G, Hutchon S, Foster C, Craft I: Percutaneous epididymal sperm aspiration (PESA). The simple alternative to microsurgical sperm retrieval (MESA). Proceedings of the 9th World Congress on in-vitro fertilisation. J Assist Reprod Genet 1995;12(3):OC270, 94S
Tsirigotis M, Boulos A, Beski A, Andritsos V, Craft I: Cumulative experience of percutaneous epididymal sperm aspiration (PESA) with ICSI. Proceedings of the 9th World Congress on in-vitro fertilisation. J Assist Reprod Genet 1995;12(3):OC274, 95S
Al-Shawaf T, Nolan A, Nadkarni P, Harper J, Brown J, Guirgis R,et al. The reproductive outcome following a superhigh response to stimulation in gamete intrafallopian programme. J Vitro Fert Embryo Transfer 1990;8:202–207
Tsirigotis M, Craft I: Sperm retrieval methods and ICSI for obstructive azoospermia. Hum Reprod 1995;10(4):758–760
World Health Organization: WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, 3rd ed. New York: Cambridge University Press, 1993, pp 3–15, 27–28
Guerin JF, Mathiew C, Lornage J, Pinatel MC, Boulieu D: Improvement of survival and fertilizing capacity of human spermatozoa in an IVF programme by selection on discontinuous Percoll gradients. Hum Reprod 1989;4:798–804
Craft I, Tsirigotis M: Simplified recovery, preparation and cryopreservation of testicular spermatozoa. Hum Reprod 1995;7:1623–1627
Cohen J, Edwards R, Fehilly C, Fishel S, Hewitt, Purdy J,et al. In vitro fertilisation: A treatment for male infertility. Fertil Steril 1985;43:422–432
Matson PL, Blackledge DG, Richardson PA, Turner SR, Yovich JM, Yovich JL: The role of gamete intrafallopian transfer (GIFT) in the treatment of oligospermic infertility. Fertil Steril 1987;48:608–612
Silber SJ, Balmaceda J, Borrero C, Ord T, Asch R: Pregnancy with sperm aspiration from the proximal head of the epididymis; A new treatment for congenital absence of the vas deferens. Fertil Steril 1988;50:525–528
Palermo G, Joris H, Devroey P, Van Steirteghem AC: Pregnancies after intracytoplasmic sperm injection of single spermatozoon into an oocyte. Lancet 1992;2:17–18
Craft IL, Tsirigotis M, Bennett V, Taranissi M, Khalifa Y, Hogewind G, Nicholson N: Percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in the management of infertility due to obstructive azoospermia. Fertil Steril 1995;63:1038–1042
Shrivastav P, Nadkarni PJ, Wensvoort S, Craft IL: Percutaneous epididymal sperm aspiration for obstructive azoospermia. Hum Reprod 1994;9:2058–2061
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Tsirigotis, M., Pelekanos, M., Beski, S. et al. Cumulative experience of percutaneous epididymal sperm aspiration (PESA) with intracytoplasmic sperm injection. J Assist Reprod Genet 13, 315–319 (1996). https://doi.org/10.1007/BF02070145
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DOI: https://doi.org/10.1007/BF02070145