Percutaneous epididymal sperm aspiration in combination with intracytoplasmic sperm injection as a treatment of choice in Obstructive azoospermia

Abstract

Intracytoplasmic sperm injection (ICSI) has proved a boon in the field of male infertility. ICSI is unique procedure in which a small quantity of progressively motile and morphologically normal spermatozoa is required and a single best-looking motile spermatozoon is injected into the oocyte. This procedure can overcome the drawbacks of poor semen quality in terms of low count, poor motility and morphology of spermatozoa. Percutaneous epidydimal sperm aspiration (PESA) is a simple procedure of retrieving spermatozoa from epididymis in cases of obstructive azoospermia. The aim of the study was to find out the cumulative rates of sperm retrieval after 2^nd PESA attempt and the feasibility of percutaneous epididymal sperm aspiration in obstructive azoospermia. A total of 100 patients were included in the study which was carried out over a period of 2 years. PESA was performed under general anaesthesia on the day of ovum pick up procedure. PESA was repeated at a different site of the same epididymis or at the contralateral site till motile spermatozoa were retrieved and processed. Sperm count motility percentage was calculated using Maklers counting chamber. In 52% of the cases (52/100), motile spermatozoa were retrieved after first PESA attempt. In cases of failure to retrieve spermatozoa after first attempt, a repeat procedure was done. In the second PESA attempt, 33%cases (16/48) reported motile spermatozoa making an overall success rate of 68%(68/100) of surgically retrieving the motile spermatozoa. The PESA remains a simple and effective technique of surgically retrieving the spermatozoa in obstructive azoospermia.