[ICSI with testicular and epididymal spermatozoa]

The use of epididymal or testicular sperm for ICSI should be employed only as a last resort to restore male reproductive function. Depending on whether the underlying cause of the infertility is obstructive or non-obstructive, prior appropriate genetic examinations are to be recommended. For the collection of sperm, microsurgical epididymal sperm aspiration (MESA) and TESE (testicular sperm extraction) are accepted methods. Today, cryopreservation of the sperm thus obtained is standard. In the event of obstructive causes, the pregnancy rate per treatment cycle is almost as high as with ICSI employing ejaculated spermatozoa. If existing genetic defects are excluded, congenital anomalies among the resulting children is presumably somewhat elevated in comparison with the normal population, although there are also studies that have failed to confirm this.