Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens.
OBJECTIVE
To present and assess the efficacy of a new approach for the treatment of infertility due to congenital bilateral absence of the vas deferens.


METHODS
A retrospective study of consecutive trials.


METHODS
Centre for Reproductive Medicine, which is a tertiary referral institution.


METHODS
Twelve couples suffering from infertility because of congenital bilateral absence of the vas deferens.


METHODS
A microsurgical epididymal sperm aspiration procedure was performed in the husbands, followed by intracytoplasmic sperm injection of oocytes recovered from the wives. Cleaving embryos were transferred to the uterine cavity 48 hours after the intracytoplasmic sperm injection procedure.


METHODS
Sperm parameters after microsurgical epididymal sperm aspiration, fertilization, cleavage, and pregnancy rates.


RESULTS
In all 14 microsurgical epididymal sperm aspiration procedures, sperm was retrieved. Notwithstanding the poor quality of this epididymal sperm, a fertilization rate of 58% was achieved after intracytoplasmic sperm injection. On 10 occasions, embryos were transferred and five patients became pregnant, i.e., an overall pregnancy rate of 35.7% per started trial and 50.0% per transfer. Another two patients became pregnant after replacement of frozen-thawed embryos, which increases the pregnancy rate to 50.0% per microsurgical epididymal sperm aspiration procedure. Early pregnancy wastage was 57%, limiting the ongoing pregnancy rate to 21.4% per microsurgical epididymal sperm aspiration procedure.


CONCLUSIONS
This study shows the combined microsurgical epididymal sperm aspiration-intracytoplasmic sperm injection procedure to be highly efficient in achieving fertilization in vitro, even after recovery of grossly impaired epididymal sperm.
Tournaye
H
H
Centre for Reproductive Medicine, University Hospital and Medical School, Dutch-speaking Brussels Free University, Belgium.
Devroey
P
P
Liu
J
J
Nagy
Z
Z
Lissens
W
W
Van Steirteghem
A
A
D000328:Adult; D004822:Epididymis / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007248:Infertility, Male / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D007315:Insemination, Artificial / Q000379:methods; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D013094:Spermatozoa / Q000166:cytology*; D013396:Suction; D014649:Vas Deferens / Q000002:abnormalities*