Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction? A comparative analysis.

Abstract

OBJECTIVE: To compare the outcomes of intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia and normal spermatogenesis, according to the use of epididymal or testicular spermatozoa and the cause of obstruction. DESIGN: Retrospective study. SETTING: Private infertility center. PATIENT(S): A detailed chart review of a cohort of 1,121 men with obstructive azoospermia who underwent intracytoplamic sperm injection (ICSI) was performed. INTERVENTION(S): Patients were grouped according to the origin of spermatozoa: epididymal (n=331) or testicular (n=790). They were further classified into two subgroups according to the cause of obstruction: congenital bilateral absence of vas deferens (CBAVD; n=434), and other causes of obstruction (n=687). MAIN OUTCOME MEASURE(S): Fertilization, clinical pregnancy, and miscarriage rates. RESULT(S): Fertilization (64.2% vs. 68.0%), clinical pregnancy (42.3% vs. 43.2%), and miscarriage (17.6% vs. 18.4%) rates did not differ between epididymal spermatozoa and testicular spermatozoa, respectively. Fertilization, clinical pregnancy, and miscarriage rates were also similar in the patients with CBAVD or due to other causes of obstruction. CONCLUSION(S): The source of sperm used for ICSI in cases of obstructive azoospermia and the etiology of the obstruction do not affect the outcome in terms of fertilization, pregnancy, or miscarriage rates.