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Hum. Reprod. Advance Access published online on December 16, 2005
Human Reproduction, doi:10.1093/humrep/dei418
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received October 13, 2005
Accepted October 26, 2005

Article

ICSI outcomes in obstructive azoospermia: influence of the origin of surgically retrieved spermatozoa and the cause of obstruction

C. Buffat 1, C. Patrat 1 *, F. Merlet 1, J. Guibert 2, S. Epelboin 3, N. Thiounn 4, A. Vieillefond 5, A. Adda-Lievin 1, C. Lebon 1, and P. Jouannet 1

1 Laboratoire de Biologie de la Reproduction; CECOS, Hôpital Cochin - Saint Vincent de Paul, Hôpitaux de Paris Université Paris V
2 Service de Gynécologie Obstétrique
3 Service de Gynécologie Obstétrique, Hôpital Saint Vincent de Paul
4 Service d’Urologie, Hôpital Necker, AP-HP, Paris, France
5 Service d’Anatomo-Pathologie, Hôpital Cochin

* To whom correspondence should be addressed.
C. Patrat, E-mail: catherine.patrat{at}cch.ap-hop-paris.fr


  Abstract

BACKGROUND: Spermatozoa can be retrieved from the testis and epididymis of men with obstructive azoospermia (OA) and used for ICSI. However, it is unknown whether the outcome of ICSI depends on the cause of obstruction or the origin of surgically retrieved spermatozoa. METHODS: A cohort of 171 men with OA and normal spermatogenesis were included in this retrospective study. They were divided into three groups according to the site and origin of obstruction: 83 men had congenital bilateral absence of vas deferens; 55 and 33 had acquired epididymal and deferent duct obstructions, respectively. The outcome of 368 ICSI cycles was determined and compared according to the origin of spermatozoa: epididymal (n = 253) or testicular (n = 115). RESULTS: Fertilization and clinical pregnancy rates did not differ between spermatozoa of different origin (58.9% versus 51.9% and 22.1% versus 24.3% with epididymal and testicular spermatozoa, respectively). However, the miscarriage rate was significantly higher for testicular spermatozoa (35.7% versus. 12.5% P < 0.05, {chi}2 test). Findings were similar whatever the aetiology of the OA. CONCLUSION: This study suggests that the use of testicular spermatozoa, even those generated during normal spermatogenesis, alters embryonic development and that epididymal spermatozoa should be preferentially used, irrespective of the aetiology of OA.

Keywords: ICSI/microsurgical epididymal sperm aspiration/obstructive azoospermia/testicular sperm extraction.
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