Zur intrazytoplasmatischen Injektion (ICSI) von Spermatozoen aus dem Nebenhoden (MESA) und dem Hoden (TESE): Eine retrospektive Analyse von über 500 Behandlungszyklen

We report on 510 treatment cycles of intracytoplasmic injection of spermatozoa (ICSI) up to the end of december 1997.The employed spermatozoa were obtained either by microsurgical spermatozoa aspiration (MESA) or testicular spermatozoa extraction (TESE). All of the 59 husbands that underwent MESA suffered from obstructive azoospermia or ejaculatory disorders. Most of the husbands being scheduled for TESE suffered from testicular insufficiency, i.e. spermatogenic disorders. A total of 198 men underwent TESE, however, in 39 of them (19,7%) we failed to find any spermatozoa - in spite of performing multilocular biopsies. Because we also failed to retrieve any spermatozoa in one MESA-patient, 217 patients remained for treatment by ICSI. Since the beginning of 1996 we abandoned the simultaneous performance of TESE/MESA and oocyte retrieval and introduced the injection of cryopreserved spermatozoa as routine. Thus, in 409 treatment cycles cryopreserved and thawed spermatozoa were used, and in 101 treatment cycles fresh spermatozoa. In 510 treatment cycles 473 embryotransfers were carried out (ET-rate: 92.7%), and no differences were found in the results between MESA and TESE, fresh and cryopreserved spermatozoa. The overall rate of clinical pregnancies was 25.8% per (single) embryotransfer, and again there were no differing results between MESA and TESE, fresh and cryopreserved spermatozoa. The same results were found for the rate of clinical abortions, which was 13.2% on average. The pregnancy rate per patient (cumulative pregnancy rate) presently is 55.7%. Because some patients are still scheduled for further treatment cycles, the cumulative pregnancy rate is likely to be higher in the end. We conclude from these results that MESA/ICSI and TESE/ICSI are effective approaches in the treatment of ejaculatory azoospermia and that cryopreservation of spermatozoa does not negatively influence the outcome. Because cryopreservation of spermatozoa has many additional advantages, it is recommended as routine in the performance of MESA/ICSI and TESE/ICSI,.