Human Reproduction, Vol. 11, No. 4, pp. 756-760, 1996
© 1996 European Society of Human Reproduction and Embryology
research-article |
Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men
1demir1
lu1lk Tademir1ak Balaban1lu11Sevgi Hospital, Assisted Reproductive Techniques and Reproductive Endocrinology Unit Tunus Caddesi No. 28, 06680 Ankara 2Department of Urology, Sevgi Hospital Ankara, Turkey 3SIMAF, Von Hclmont Hospital, Fertility Unit Vilvoorde, Belgium
Correspondence: 4To whom correspondence should be addressed
In non-obstructive azoospermia spermatozoa can usually only be isolated from the testicles, and thus the most promising treatment model is testicular sperm extraction (TESE). Hormone concentrations, testicular volume determinations and testicular biopsy results are not uniform enough to select potential candidates for successful TESE and intracytoplasmic sperm injection (ICSI) approaches in advance. The aim of this study was to assess the efficacy of using ICSI with testicular spermatozoa in cases of non-obstructive azoospermia and to compare the inclusion criteria and sperm existence in the testicles in sperm obtainable and non-obtainable groups. All men showed either complete or incomplete (n = 14) maturation arrest in spermatogenesis, severe hypospermatogenesis (n = 10) or Sertoli cell-only syndrome (n = 5) in their testicular biopsies. Only 14 out of a total of 29 men provided enough spermatozoa for the ICSI procedure, while no spermatozoa were found in the testicular samples of the remaining 15 men. Out of 123 oocytes obtained from 14 females, 101 were injected with the husbands' testicular sperm cells. Total fertilization failure was observed in three cases. Of 39 oocytes fertilized, 38 cleaved. The fertilization and cleavage rates were 38.6 and 97.4% respectively. The pregnancy rate was 20.7% per initiated cycle. In the group from whom spermatozoa were obtainable, the pregnancy rate was 42.9% per initiated cycle and 54.5% per embryo transfer. A total of six pregnancies were achieved, of which two Were twins and four were singletons. One singleton pregnancy resulted in abortion in the first trimester. There was no statistical difference concerning the serum follicle stimulating hormone concentration, testicular volume and biopsy results in groups in which spermatozoa were obtainable or not. In conclusion, although the association of TESE with ICSI obtained pregnancies for some patients with non-obstructive azoospermia, further studies are needed to determine the inclusion criteria for successful TESE.
Key words: fertility/intracytoplasmic sperm injection/non-obstructive azoospermia/testicular sperm extraction
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