Sperm retrieval for azoospermia and intracytoplasmic sperm injection success rates--a personal overview

It is often questioned whether sperm parameters, including whether retrieved or ejaculated, have any effect on intracytoplasmic sperm injection (ICSI) results. Do severe spermatogenic defects affect embryo quality or pregnancy rate? Further, does it matter in azoospermic patients whether the sperm source is testicular or epididymal? Our studies show there is no significant difference in results with ICSI related to any sperm count parameters either with patient's sperm or even with donor sperm. No matter how poor the sperm count, there was no difference from patients with high sperm counts nor even patients using donor sperm. There is no significant difference between results with epididymal sperm, either fresh or frozen, in comparison to results with ejaculated or donor sperm. However, both pregnancy rate and delivery rate were considerably lower with testicular sperm (testis sperm extraction) than with epididymal sperm (microsurgical epididymal sperm aspiration). This was true for overall results as well as in each category of the female partner's age. It is obvious that in all these cycles the female partner's age was the most important determinant of delivery rate, but testicular sperm always yielded lower results than epididymal sperm. These results show that it is the origin of the sperm rather than the spermatogenic defect that determines success rate with ICSI.