Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients

Objective: To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. Design: Retrospective study. Setting: Academic medical center and private fertility center. Patient(s): Two hundred twelve patients underwent 257 ICSI cycles. Intervention(s): Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. Main Outcome Measure(s): Fertilization, pregnancy, and miscarriage rates. Result(s): Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). Conclusion(s): Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm. (c) 2005 by American Society for Reproductive Medicine.