title: Efficacy of microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) in obstructive azoospermia.
abstract: OBJECTIVE
  Our purpose was to test whether micromanipulation using subzonal insemination and intracytoplasmic sperm injection could improve the poor fertilization and pregnancy rates obtained when attempting in vitro fertilization in patients with congenital absence of the vas deferens and unreconstructable obstructive azoospermia with microsurgically retrieved epididymal spermatozoa.
  
  
  RESULTS
  Conventional in vitro fertilization (group A; 14 cycles), subzonal insemination (group B; 13 cycles), and intracytoplasmic sperm injection (group C; 28 cycles) were carried out in 55 treatment cycles. Fertilization rates for groups A, B, and C were 16.1, 31.4, and 48.6%, respectively (P < 0.05). Clinical pregnancy rates for groups A, B, and C were 7.1, 7.7, and 32.1% (P < 0.05), respectively. In five cycles, intracytoplasmic sperm injection using epididymal sperm from alloplastic spermatoceles was performed and two clinical pregnancies (40%) were obtained.
  
  
  CONCLUSIONS
  The combined microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection procedure is highly effective in improving the fertilization and pregnancy rate in congenital absence of the vas deferens and unreconstructable obstructive azoospermia. Furthermore, alloplastic spermatoceles may be useful for repeat sperm aspirations.
authors.affiliation: Department of Obstetrics and Gynecology, Cheil General Hospital, Seoul, Korea.
authors.forename: I P
authors.initials: IP
authors.lastname: Son
authors.forename: J Y
authors.initials: JY
authors.lastname: Hong
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
authors.forename: Y S
authors.initials: YS
authors.lastname: Park
authors.forename: J H
authors.initials: JH
authors.lastname: Jun
authors.forename: H J
authors.initials: HJ
authors.lastname: Lee
authors.forename: I S
authors.initials: IS
authors.lastname: Kang
authors.forename: J Y
authors.initials: JY
authors.lastname: Jun
mesh_terms: D004822:Epididymis / Q000378:metabolism / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000151:congenital / Q000175:diagnosis; D008297:Male; D011247:Pregnancy; D013088:Spermatocele / Q000378:metabolism; D013094:Spermatozoa / Q000002:abnormalities / Q000378:metabolism*; D014649:Vas Deferens / Q000002:abnormalities*