Intracytoplasmic Sperm Injection with Testicular Sperm Extraction in Patients with Obstructive and Non-obstructive Azoospermia

Kim, J H; Chae, H D; Kang, E H; Jeon, Y P; Hong, S H; Kang, B M; Ahn, T Y; Chang, Y S

Abstract

OBJECTIVE
To evaluate the results of intracytoplasmic sperm injection [ICSI] with testicular sperm extraction [TESE] in men suffering from obstructive and non-obstructive azoospermia.
METHODS
From December 1995 to January 1999, 26 patients with obstructive azoospermia and 21 patients with non-obstructive azoospermia were included in the study. In all patients, TESEs were performed to retrieve sperm which was used for ICSI. The results of ICSI were compared in obstructive versus non-obstructive azoospermia and also compared according to the status of sperm in patients with non-obstructive azoospermia.
RESULTS
Serum follicle stimulating hormone [FSH] level of patients was significantly higher in the non-obstructive group than in the obstructive group. However, other parameters in patient`s characteristics were comparable in both groups. Thirty-six ICSI cycles were performed in the obstructive group and 33 ICSI cycles were performed in the non-obstructive group. The number of fertilized oocytes and fertilization rate were significantly higher in the obstructive group than in the non-obstructive group [p < 0.05; p < 0.001, respectively]. The clinical pregnancy rate per ICSI cycle seemed to be higher in the obstructive group, but the difference did not achieve significance [33.3% vs 18.2%]. There were no differences in the miscarriage rate and multiple pregnancy rate between the two groups. In the non-obstructive group, fertilization rate was significantly higher in the group with mixed motile and immotile spermatozoa than in the group with only immotile spermatozoa or the group with spermatids [p < 0.005]. However, there were no significant differences in the clinical pregnancy rate per ICSI cylce, miscarriage rate and multiple pregnancy rate among 3 groups.
CONCLUSION
Our data demonstrate that ICSI with TESE in patients with obstructive azoospermia results in significantly high fertilization rate as compared to non-obstructive cases. In addition, ICSI using motile spermatozoa results in high fertilization rate as compared to ICSI using immotile spermatozoa or spermatids.