title: Epididymal micropuncture with in vitro fertilization and oocyte micromanipulation for the treatment of unreconstructable obstructive azoospermia.
abstract: OBJECTIVE
  To provide fertility to couples in whom the man has surgically unreconstructable obstructive azoospermia.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Hospital-based IVF unit, including associated division of urologic microsurgery.
  
  
  METHODS
  Couples referred to our fertility unit for treatment of men with surgically unreconstructable reproductive tract obstruction, including congenital absence of the vas deferens.
  
  
  METHODS
  Fertilization, pregnancies, and live births.
  
  
  RESULTS
  Of 51 cycles in which sperm and eggs were retrieved, 67% (34/51) resulted in fertilization and 27.5% (14/51) developed clinical pregnancy. Clinical pregnancy rate per couple was 33% (14/43). A total of 15 live births have been obtained in 11 couples with one ongoing pregnancy. Epididymal length was the best predictor of sperm quality and pregnancy results. For couples with at least the corpus epididymis present, 41% (9/22) of cycles resulted in clinical pregnancies.
  
  
  CONCLUSIONS
  Pregnancy rates are optimized using sperm retrieved from the epididymis by micropuncture and when micromanipulation is available for use during IVF.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center 10021.
authors.forename: P N
authors.initials: PN
authors.lastname: Schlegel
authors.forename: A S
authors.initials: AS
authors.lastname: Berkeley
authors.forename: M
authors.initials: M
authors.lastname: Goldstein
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Alikani
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.forename: B R
authors.initials: BR
authors.lastname: Gilbert
authors.forename: Z
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D002470:Cell Survival / Q000502:physiology; D004624:Embryo Transfer; D004822:Epididymis / Q000502:physiology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015994:Incidence; D008297:Male; D009845:Oligospermia / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D009865:Oocytes / Q000166:cytology / Q000502:physiology*; D011247:Pregnancy / Q000502:physiology; D011446:Prospective Studies; D011677:Punctures; D013094:Spermatozoa / Q000166:cytology / Q000502:physiology; D013514:Surgical Procedures, Operative / Q000379:methods