title: A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia.
abstract: BACKGROUND
  Obstructive azoospermia (OA) is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization (IVF) combined with PESA in cases of men with OA.
  
  
  OBJECTIVE
  To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens.
  
  
  METHODS
  The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years (2002-2010) were retrospectively reviewed. Patients requiring testicular intervention were excluded (n = 17).
  
  
  RESULTS
  Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients (78.4%) simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer (12.5%). Pregnancies were confirmed in 48.6% (17/35). Twin gestations occurred in 11.8% (2/17) of cases. Frozen-thawed spermatozoa were used in 11 patients (21.6%). In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% (6/11). No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens.
  
  
  CONCLUSIONS
  PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, Texas, 77030, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kovac
authors.affiliation: McMaster Institute of Urology, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Lehmann
authors.affiliation: McMaster Institute of Urology, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
authors.forename: Marc Anthony
authors.initials: MA
authors.lastname: Fischer
keywords: Infertility; obstructive azoospermia; percutaneous epididymal sperm aspiration