title: The use of epididymal spermatozoa in assisted reproduction.
abstract: The use of epididymal spermatozoa in assisted reproduction (ART) permits fertility in men with surgically irremediable obstructive azoospermia. When used for conventional IVF (sperm-oocyte co-culture), epididymal spermatozoa show reduced fertilization and pregnancy rates (compared with ejaculated spermatozoa from men with a range of spermatogenic disorders) as evidence of their functional immaturity. However, when used with intracytoplasmic sperm injection (ICSI) either fresh or frozen-thawed epididymal spermatozoa produce ART success rates similar to those of ejaculated spermatozoa. The clinical place of epididymal sperm retrieval for ICSI has come under review as a result of data showing similarly good outcomes with testicular spermatozoa obtained by needle aspiration. In Australia ICSI using epididymal or testicular spermatozoa is an increasingly favoured option for vasectomy-related infertility and in other types of obstructive azoospermia for a number of reasons including better pregnancy outcomes, the less invasive nature of the procedures and less expense involved; however, this cost-benefit analysis will vary in other health systems.
authors.affiliation: Prince Henry's Institute of Medical Research, Monash Medical Centre, Clayton, Australia.
authors.forename: R I
authors.initials: RI
authors.lastname: McLachlan
mesh_terms: D003251:Constriction, Pathologic / Q000150:complications; D004822:Epididymis; D004823:Epididymitis / Q000150:complications; D006801:Humans; D007248:Infertility, Male / Q000209:etiology; D008297:Male; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa; D020858:Tissue and Organ Harvesting; D014649:Vas Deferens / Q000002:abnormalities; D014659:Vasectomy