High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy

In cases requiring microsurgical epididymal sperm aspiration (MESA) for congenital absence of the vas deferens (CAVD) or irreparable obstructive azoospermia, often no spermatozoa can be retrieved from the epididymis, or there may even be no epididymis present. We wished to see whether testicular biopsy with testicular sperm extraction (TESE) in such cases could yield spermatozoa that would result in successful fertilization and pregnancy (despite the absence of epididymal spermatozoa) using intracytoplasmic sperm injection (ICSI). In the same setting during the same 2-week period, 28 patients with CAVD or irreparable obstruction were treated; 16 consecutive fresh MESA-ICSI cycles and 12 cycles which required testicular biopsy with testicular sperm extraction (TESE-ICSI) were performed. Normal two-pronuclear fertilization rates were similar in both groups: 45% for epididymal spermatozoa and 46% for testicular biopsy-extracted spermatozoa. Cleavage rates were also similar (68% for epididymal and 65% for testicular spermatozoa). The ongoing pregnancy rates in this series were 50 and 43% respectively. We conclude that epididymal spermatozoa and testicular spermatozoa yield similar fertilization, cleavage and ongoing pregnancy rates using ICSI. When epididymal spermatozoa cannot be retrieved, a testicular biopsy can be performed and the few barely motile spermatozoa thus obtained can be used for ICSI. It appears that all cases of obstructive azoospermia can now be successfully treated.