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Korean Journal of Obstetrics & Gynecology 1999;42(5):997-1005.
Published online January 1, 2001.
Comparison of Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Obstructive Azoospermia according to Sperm Retrieval Site and Technique.
S H Kim, B J Jung, B C Jee, S M Choi, H S Kim, B Y Ryu, S K Oh, C S Suh, Y M Choi, J K Kim, S Y Moon, J Y Lee
Abstract
OBJECTIVE
To compare the clinical outcomes of intracytoplasmic sperm injection[ICSI] in patients with obstructive azoospermia according to sperm retrieval site and technique ; microsurgical epididymal sperm aspiration[MESA], percutaneous epididymal sperm aspiration [PESA], testicular biopsy-gun sperm extraction[TBSE] and testicular sperm extraction by open biopsy[TESE]. METHODS: Sixty men suffering from infertility due to obstructive azoospermia had 85 ICSI cycles using MESA[12 cycles in 12 patients], PESA[43 cycles in 27 patients], TBSE[26 cycles in 17 patients] or TESE[4 cycles in 4 patients]. The outcomes of ICSI and IVF-ET were evaluated and compared among 4 groups. Statistical analysis was carried out using the SPSS PC statistical package at the 5% level of significance. RESULTS: Comparing the clinical outcomes in patients undergoing ICSI with epididymal or testicular sperm, there were no significant differences in fertilization rate[63.9% vs. 66.6%], cleavage rate[83.0% vs. 92.7%], cumulative embryo score[CES][52.4 vs. 50.1], implantation rate[8.0% vs. 7.0%], and clinical pregnancy rate per ET[27.8%[15/54] vs. 21.4%[6/28]] between both groups. Comparing the clinical outcomes in ICSI patients using MESA, PESA, TBSE or TESE, more numbers of oocytes retrieved and fertilized[2PN] were obtained in MESA group. However, there were no significant differences in fertilization rate[68.9%, 62.4%, 66.9%, 64.2%], cleavage rate[82.7%, 83.1%, 93.2%, 90.0%], CES[65.5, 48.7, 50.6, 46.0], implantation rate[10.0%, 7.4%, 7.1%, 6.7%], and clinical pregnancy rate per ET[50.0%[6/12], 21.4%[9/42], 24.0%[6/25], 0%[0/3]] among 4 groups. CONCLUSIONS: Both fertilization and clinical pregnancy rates were similar in ICSI patients with obstructive azoospermia whatever the origin or the technique of sperm retrieval. When compared with MESA or TESE, PESA and TBSE are more time-saving and cost effective for ICSI in patients with obstructive azoospermia.
Key Words: Male factor infertility, Obstructive azoospermia, Sperm retrieval, Microsurgical epididymal sperm aspiration[MESA], Percutaneous epididymal sperm aspiration[PESA], Testicular biopsy-gun sperm extraction[TBSE], Testicular sperm extraction[TESE]


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