Testicular and epididymal percutaneous sperm aspiration in men with either obstructive or nonobstructive azoospermia

To investigate our experience with epididymal and testicular sperm obtained by percutaneous aspiration to determine the effectiveness of these procedures in patients with obstructive or nonobstructive azoospermia. We also report on the pooled outcome of intracytoplasmic sperm injection, performed at six in vitro fertilization centers, using sperm from these two patient populations.

A method of percutaneous aspiration of sperm was developed to facilitate diagnostic biopsy and therapeutic aspiration. A total of 265 aspirations were performed for diagnostic and therapeutic purposes from August 1995 through July 2001.

Mature sperm were found in 34 (47%) of 73 men with nonobstructive azoospermia, who underwent testicular sperm aspiration for diagnostic purposes. In 56 procedures for men with nonobstructive azoospermia who underwent testicular sperm aspiration for intracytoplasmic sperm injection, an adequate number of viable sperm was obtained from 46 (82%), with an oocyte fertilization and clinical pregnancy rate of 55% and 44%, respectively. In men with obstructive azoospermia who underwent percutaneous epididymal sperm aspiration, viable sperm were found in 91 (97%) of 94 procedures, with an oocyte fertilization and clinical pregnancy rate of 58% and 39%, respectively. Sperm were obtained in 18 (100%) of 18 procedures in men with obstructive azoospermia who underwent testicular sperm aspiration, with a corresponding fertilization and clinical pregnancy rate of 51% and 38%, respectively. A small (less than 1 cm in diameter) subcapsular hematoma was the only complication.

Percutaneous aspiration of sperm is an effective, safe, and reproducible means of obtaining adequate sperm for diagnosis or intracytoplasmic sperm injection in patients with obstructive or nonobstructive azoospermia. Our experience indicates that similar results can be obtained in both patient groups.