title: Sperm retrieval procedures and intracytoplasmatic spermatozoa injection with epididymal and testicular sperms.
abstract: BACKGROUND
  Male infertility caused by azoospermia due to non-reconstructable obstruction or non-obstructive azoospermia can be treated by microsurgical epididymal aspiration (MESA) or testicular sperm extraction (TESE) followed by an intracytoplasmatic spermatozoa injection (ICSI).
  
  
  METHODS
  From 9/93 to 6/01, we carried out 1,025 ICSI procedures with aspirated epididymal or testicular sperms in 684 cases. 163 ICSI cycles were performed with epididymal sperms and 862 ICSI cycles with testicular sperms or spermatids. The TESE was carried out by open biopsy, frequently in a multilocular technique. The aspirated spermatozoas were used after cryopreservation (frozen) or immediately after aspiration (fresh).
  
  
  RESULTS
  538 patients had obstructive azoospermia or ejaculation failure. In 487 cases the underlying cause of azoospermia was an impaired spermatogenesis, following maldescensus testis, chemotherapy, radiotherapy, or caused by Sertoli-cell-only syndrome, a genetic disorder or an unknown etiology. The transfer rates, pregnancy rates and birth rates per ICSI cycle showed no statistically significant differences between testicular and epididymal sperms in the cases of seminal obstruction (28% average birth rates in both cases). However, highly significant was the difference in birth rates with regard to the underlying cause of infertility. In contrast, in treating non-obstructive azoospermia we observed a birth rate of 19% per cycle. In all patient groups the birth rate with fresh spermatozoas did not differ from those with cryopreserved spermatozoa. 40% of patients after multilocular TESE showed clinical signs of testicular lesion.
  
  
  CONCLUSIONS
  The underlying cause of azoospermia is the most important factor for the outcome of ICSI using epididymal and testicular sperms. In cases of non-obstructive azoospermia, the pregnancy rate is low compared with the results in cases of obstructive azoospermia. There is no difference between fresh and cryopreserved sperms. TESE with ICSI is the most efficient treatment of azoospermia caused by hypergonadotropic hypogonadism. The morbidity of the TESE procedure is highly relevant and must be considered if this technique is indicated.
authors.affiliation: The Munich Group of Reproductive Medicine, Frauenklinik Dr. Krüsmann, Germany. J.U.Schwarzer@gmx.de
authors.forename: J Ullrich
authors.initials: JU
authors.lastname: Schwarzer
authors.forename: Klaus
authors.initials: K
authors.lastname: Fiedler
authors.forename: Irene
authors.initials: I
authors.lastname: v  Hertwig
authors.forename: Gottfried
authors.initials: G
authors.lastname: Krüsmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Würfel
authors.forename: Manfred
authors.initials: M
authors.lastname: Schleyer
authors.forename: Bärbel
authors.initials: B
authors.lastname: Mühlen
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pickl
authors.forename: Dieter
authors.initials: D
authors.lastname: Löchner-Ernst
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015925:Cryopreservation; D004822:Epididymis / Q000166:cytology*; D006801:Humans; D008297:Male; D008845:Microinjections; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009845:Oligospermia / Q000175:diagnosis / Q000628:therapy*; D012099:Reproductive Techniques; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013075:Sperm Capacitation; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013396:Suction; D013737:Testis / Q000166:cytology*