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Testicular and epididymal sperm in a microinjection program: methods of retrieval and results
1Reproductive Biology Unit, Royal Women's Hospital, Carlton, Victoria, Australia.
Objective:
To describe the methods of collection and laboratory preparation of epididymal and testicular sperm; to compare the fertilization and pregnancy rates; and to establish prognostic factors.
Design:
Retrospective analysis.
Setting:
Academic reproductive medicine clinic.
Patient(S):
One hundred twelve consecutive microinjection cycles in 80 patients using either epididymal or testicular sperm.
Intervention(S):
Sperm were collected by microepididymal sperm aspiration, open testicular biopsy, or fine needle tissue aspiration testicular biopsy.
Main Outcome Measure(S):
Fertilization rate, implantation, and clinical pregnancy rates.
Result(S):
The fertilization rate was higher with epididymal sperm (67%) than with testicular sperm (50%). Implantation rates (fetal hearts per embryo, testicular: 11%, epididymal: 8%) and pregnancy rates (clinical pregnancy per oocyte collection procedure, testicular: 25%, epididymal: 29%) were not significantly different with epididymal and testicular sperm. Multiple regression analysis showed that normal fertilization rates were significantly lower with testicular sperm, immotile sperm, and severe spermatogenic disorders.
Conclusion(S):
Although fertilization rates are significantly lower with testicular sperm, higher implantation rates resulted in equivalent pregnancy rates. Thus, testicular aspiration of sperm for intracytoplasmic sperm injection is a simple, inexpensive method of sperm retrieval in cases of azoospermia resulting from genital tract obstruction or severe spermatogenic disorder.