title: The outcome of intracytoplasmic sperm injection using occasional spermatozoa in the ejaculate of men with spermatogenic failure.
abstract: OBJECTIVE
  Men with spermatogenic failure so profound that they are considered as having nonobstructive azoospermia occasionally have spermatozoa in the ejaculate. We compared intracytoplasmic sperm injection outcomes following the injection of ejaculated or surgically retrieved spermatozoa from these men.
  
  
  METHODS
  A study was performed of intracytoplasmic sperm injection cycles with no spermatozoa on initial semen analysis and 100 or fewer following centrifugation (cryptozoospermia). Only 16 couples that underwent intracytoplasmic sperm injection cycles with ejaculated spermatozoa and cycles with testicular spermatozoa were included.
  
  
  RESULTS
  Initial analysis was done to compare outcomes between the 2 semen origins. There was no difference in the rate of normal or abnormal fertilization between the 2 groups. The rate of clinical pregnancies seemed to favor testicular spermatozoa (47.4% vs 20.8%), although results were not significant. When a comparison was performed between the first testicular cycle and the ejaculated cycle closest in time to the cycle with testicular spermatozoa, a higher rate of normal fertilization with testicular spermatozoa was observed (60.9% vs 48.5%, p <0.05). Also, in this comparison a clear trend toward a higher percent of clinical pregnancies and deliveries in the testicular group was observed (50.0% vs 14.3%).
  
  
  CONCLUSIONS
  Transit through the male genital tract did not enhance the ability of ejaculated spermatozoa to achieve fertilization with intracytoplasmic sperm injection compared to that of testicular spermatozoa in men with severely impaired production. In ejaculated samples a lower number of spermatozoa available resulted in an impaired chance of achieving pregnancy. Using testicular spermatozoa may be a reasonable alternative for couples in whom multiple attempts at intracytoplasmic sperm injection have failed using ejaculated sperm from men with cryptozoospermia.
authors.affiliation: Center for Reproductive Medicine and Infertility, Weill Medical College of Cornell University, New York, New York 10021, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Bendikson
authors.forename: Queenie V
authors.initials: QV
authors.lastname: Neri
authors.forename: Takumi
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Marco
authors.initials: M
authors.lastname: Toschi
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
authors.forename: Zev
authors.initials: Z
authors.lastname: Rosenwaks
authors.forename: Gianpiero D
authors.initials: GD
authors.lastname: Palermo
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome