Technological improvements suggest the preferential use of percutaneous epididymal sperm aspiration (PESA) over surgical correction in the treatment of obstructive azoospermia (OA)

Abstract

OBJECTIVE: OA is common and characterized by normal spermatogen- esis and the absence of sperm in the ejaculate, fertility may be achieved with either in-vitro fertilization (IVF) in association with surgical sperm retrieval including PESA, or reconstructive surgery. Pregnancy rates of 32-40% are quoted with IVF and PESA compared to the variable rates obtained with vasectomy reversal - values mostly dependent on the duration of obstruction. Given the recent improvements IVF, we sought to determine pregnancy outcomes of couples undergoing PESA and IVF. DESIGN: Retrospective chart review. MATERIALS AND METHODS: The charts of 68 consecutive couples who underwent 68 cycles of sperm retrieval for OA and had IVF from 2002 to 2010 were analyzed with patients requiring testicular intervention excluded (n = 17). RESULTS: Viable sperm were identified in 100% of men who underwent PESA. Fresh spermatozoa were obtained in 40 patients (78%) simultaneously with female egg retrieval. In this subgroup, males were aged 34 +/- 1 years with a partner age of 40 +/- 1 years. The average fertilization rate was 77% with 5 embryos not surviving to transfer (12.5%). Of those who had successful embryo transfer, pregnancy was confirmed in 48% (17/35). Twin gestations were produced in 12% (2/17). Frozen-thawed PESA spermatozoa were used in 11 patients (22%). In this subgroup, males were aged 34 +/- 1 years with a partner age of 37 +/- 1 years. The average fertilization rate was 74% with pregnancy confirmed in 55% (6/11). No multiple gestations were generated using frozen-thawed spermatozoa and no complications were identified in any PESA procedure. CONCLUSION: PESA is an effective means of obtaining spermatozoa for use in IVF given patients with OA. Our results show improvements in the cumulative fertilization (76.2%) and pregnancy (50%) rates compared to previous studies (58-65% and 32-40% respectively). Given the improvements in technology, further research into the preferential use of IVF and PESA over surgical correction in OA is required.