Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia

Abstract

Objectives: Assessing the efficiency of repeated percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia, and also the possibility of cryopreservation of remaining material for future use in intracytoplasmic sperm injection (ICSI).Method: Retrospective study, in which 79 procedures of PESA were assessed in 58 patients (mean age = 45 years), whose partners had mean age of 34 years. Vasectomy was the most frequent cause of obstructive azoospermia (n = 46).Results: Motile spermatozoa were obtained in 65 procedures (82%). PESA was twice repeated for 15 patients, 3 times for 5 patients, and 4 times for 1 patient. Spermatozoa were found in 13 (87%) patients in the second attempt, in 4 (80%) patients in the third attempt, and in the only patient that had accomplished 4 procedures. In 30 procedures (37%), we have obtained enough material for cryopreservation. In 12 among the 13 samples thawed (n = 13 patients), motile spermatozoa were found, and ICSI was accomplished. Four patients that did not use their samples requested the elimination of the material. Total rate of pregnancy per transference was 21/55 (38%). In 14 PESA procedures, it was not possible to find spermatozoa; in these cases, the patients opted for accomplishing the procedure of testicular sperm aspiration (TESA).Conclusion: PESA is an efficient and simple method of retrieving spermatozoa, allowing repeated procedures. Additionally, spermatozoa collected through PESA can be cryopreserved.

Impact of sperm retrieival on testis and epididymis: an experimental study using Wistar albino rats

“…The use of intracytoplasmic sperm injection (ICSI) in clinical practice revolutionized the treatment of patients with severe male factor of infertility [Palermo et al 1993;Devroey et al 1995;Glina et al 2003]. While initially this type of treatment was limited to patients with obstructive azoospermia [Craft et al 1997;Schoysman et al 1993], later studies reported the successful recovery of mature sperm in patients with non-obstructive azoospermia [Devroey et al 1995] leading to the first successful pregnancies and deliveries in this later group of infertile patients [Tournaye et al 1995;Lewin et al 1996].…”

“…These procedures can cause physiological consequences leading to several side effects, such as inflammation and haematomas [Schlegel and Su 1997;Ramasamy et al 2005], progressive and irreversible damage to the architecture of the tubules, fibrotic changes [Shufaro et al 2002], testicular atrophy and impaired Leydig cell function [Tash and Schlegel 2001;Bouloux et al 2002;Schill et al 2003]. The pathological changes increased when the procedure was repeated on the same subject [Glina et al 2003]. Surprisingly, published reports indicate that there is lack of consensus to recommend any particular sperm retrieval technique [Van Peperstraten et al 2006;Donoso et al 2007;Rupin 2011;Esteves et al 2011].…”

Reproductive Potential of Men with Obstructive Azoospermia Undergoing Percutaneous Sperm Retrieval and Intracytoplasmic Sperm Injection According to the Cause of Obstruction

“…5 The literature is rich in studies of the outcomes of sperm acquisition and ICSI. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Nevertheless, few groups have reported SR outcomes in men with OA according to obstruction etiology. 13,14,16 -18 This is important to determine because it will help infertility physicians counsel such patients on the chances of SR and ICSI.…”

Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: Do etiology, retrieval techniques and gamete source play a role?

“…Successful repeated PESA was performed up to three times, with recovery of motile sperm in over 80% of the cases. Forty-three percent of PESA procedures yielded sufficient spermatozoa to allow cryopreservation (42). Esteves et al reported a SRR of 97.9% among 142 men with OA.…”