Should cryopreserved epididymal or testicular sperm be recovered from obstructive azoospermic men for ICSI?


Dr S. D. Keay, Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, England, UK.


Objective  To determine the effect of the anatomical site of sperm recovery on intracytoplasmic sperm injection (ICSI) embryo implantation, pregnancy and live birth rates in couples with isolated obstructive azoospermia as the sole cause of infertility.

Design  Controlled, single centre, retrospective clinical study.

Setting  University Hospital, Centre for Reproductive Medicine.

Sample  One hundred and fifty-one cycles of ICSI were performed, using surgically recovered sperm, between August 1996 and March 2002.

Methods  The outcome of ICSI, with surgically recovered sperm, was compared between epididymal (Group E) and testicular (Group T) derived sperm. Inclusion was limited to couples undergoing their first treatment cycle, where female age was ≤39 years and a minimum of five oocytes were available for injection. Women with a history of ovarian surgery, ultrasonic evidence of polycystic ovaries, uterine anomalies or hydrosalpinx were excluded.

Main outcome measures  Clinical pregnancy, implantation and live birth rate.

Results  Forty-two of 151 cycles met the strict inclusion criteria. Groups E and T were comparable with respect to age, basal serum FSH, ovarian response; number of oocytes injected and number of embryos available and transferred. No difference existed between Groups E and T in implantation, clinical pregnancy or live birth rate (28.8%vs 25.8%, 42.9%vs 42.9% and 39.3%vs 42.9%, respectively).

Conclusions  Cryopreserved epididymal and testicular sperm, from men with obstructive azoospermia, appear equally effective in ICSI. Epididymal recovery should remain the method of first choice for obstructive azoospermic men but further study of sperm DNA damage rates in different testicular sites is required.