Epididymal sperm in assisted reproductive technology

Area of Science:

• Reproductive Medicine
• Andrology
• Surgical Urology

Background:

• Obstructive azoospermia, particularly congenital absence of the vas deferens (CAVD), presents a significant cause of male infertility.
• Recent advancements in microsurgical techniques have enabled sperm retrieval from the epididymis for assisted reproductive technologies.
• This offers a potential pathway to biological fatherhood for affected men.

Purpose of the Study:

• To report the clinical outcomes of microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilisation (IVF) and tubal embryo transfer (TET) in men with obstructive azoospermia.
• To evaluate the efficacy of MESA/IVF/TET in achieving pregnancies in this patient population.
• To assess the feasibility of embryo cryopreservation for future use.

Main Methods:

• Microsurgical epididymal sperm aspiration (MESA) was performed on 98 consecutive infertile men with obstructive azoospermia, primarily due to CAVD.
• Retrieved epididymal sperm were used for in vitro fertilisation (IVF) of human oocytes.
• Fertilised embryos were transferred via tubal embryo transfer (TET).

Main Results:

• A fertilisation rate of 17% and a pregnancy rate of 36% per embryo transfer were achieved.
• Of 18 pregnancies, 13 resulted in live births at term, while 5 (27%) ended in abortion.
• Cryopreservation of surplus embryos was successful for 13 couples, offering future reproductive options.

Conclusions:

• MESA in conjunction with IVF/TET is a clinically effective procedure for achieving pregnancies in men with obstructive azoospermia due to CAVD.
• This approach provides a valuable option for infertile men to father their own biological children.
• The study also facilitated investigations into spermatogenesis and sperm disposal in chronic obstruction.