title: Micropuncture retrieval of epididymal sperm with in vitro fertilization: importance of in vitro micromanipulation techniques.
abstract: OBJECTIVE
  To evaluate the importance of in vitro micromanipulation techniques, specifically intracytoplasmic sperm injection (ICSI), for the fertility treatment of men with congenital absence of the vas deferens (CAV) or other unreconstructable male reproductive tract obstruction.
  
  
  METHODS
  Results using ICSI during in vitro fertilization (IVF) were compared to previously published results of IVF alone and IVF with other micromanipulation techniques at the same infertility center. Main outcome parameters evaluated were: fertilization rate per oocyte, clinical pregnancy rate, and ongoing pregnancies and deliveries.
  
  
  RESULTS
  IVF with ICSI yielded a fertilization rate per oocyte of 140 of 312 (45%) and a clinical pregnancy rate of 14 of 27 (52%) per cycle of sperm and egg retrieval. Ongoing pregnancies or deliveries have occurred for 13 of 27 (48%) cycles with ICSI. These results were better than our previously published results of IVF alone or in conjunction with the micromanipulation techniques of subzonal insertion (SuZI) or partial zona dissection (PZD) that yielded a 119 of 631 (19%; P < 0.0001) fertilization rate, clinical pregnancy rate of 14 of 51 (27%; P < 0.001) and ongoing pregnancy or delivery for 12 of 51 cycles (24%; P < 0.001).
  
  
  CONCLUSIONS
  Epididymal sperm retrieval should be performed only when micromanipulation is available in conjunction with IVF to maximize chances of fertilization and subsequent pregnancies. The use of ICSI for epididymal sperm appears to maximize chances of pregnancy for couples with surgically unreconstructable obstructive male infertility.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, New York 10021 USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Schlegel
authors.forename: G D
authors.initials: GD
authors.lastname: Palermo
authors.forename: M
authors.initials: M
authors.lastname: Alikani
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.forename: A M
authors.initials: AM
authors.lastname: Reing
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: Z
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D003593:Cytoplasm; D004624:Embryo Transfer; D004822:Epididymis / Q000601:surgery; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy*; D008297:Male; D008846:Micromanipulation / Q000379:methods*; D009865:Oocytes; D011247:Pregnancy; D011677:Punctures; D013094:Spermatozoa; D014649:Vas Deferens / Q000002:abnormalities