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J Assist Reprod Genet. 2013 Sep;30(9):1175-9. doi: 10.1007/s10815-013-0075-1. Epub 2013 Aug 29.

Percutaneous epididymal sperm aspiration and short time insemination in the treatment of men with obstructive azoospermia.

Author information

  • 1Department of Histology and Embryology, Hebei Medical University, Shijiazhuang, 050017, China, 13932117427@163.com.

Abstract

OBJECTIVE:

To study the efficacy of percutaneous epididymal sperm aspiration (PESA) in combination with short time insemination to treat infertile men with obstructive azoospermia (OA).

DESIGN:

Paired randomized controlled trial in which each couple's cohort of oocytes was divided into two equal groups.

SETTING:

Center for reproductive care.

PATIENTS:

Twenty men with OA.

INTERVENTIONS:

Motile spermatozoa were collected using PESA. Half of the oocytes were used for intracytoplasmic sperm injection (ICSI). The rest were inseminated briefly with PESA sperm in vitro fertilization (IVF). After 4-5 h, the remaining cumulus cells were removed mechanically for second polar body observation to decide whether to apply "rescue" ICSI (RE-ICSI).

MAIN OUTCOME MEASURES:

Rates of oocyte maturation, fertilization, cleavage, and good quality embryos. Numbers of available embryos and good quality embryos were compared between PESA-IVF (using a short incubation protocol + rescue ICSI) group and PESA-ICSI group.

RESULTS:

In the short time insemination group, cumulus cells were dispersed by PESA spermatozoa. No second polar bodies were found, so RE-ICSI was done. PESA-IVF + RE-ICSI and PESA-ICSI outcomes were comparable in terms of fertilization rates, 2PN cleavage rate and good quality embryo rates with no statistically significant differences.

CONCLUSIONS:

PESA sperm without centrifugation could disperse the cumulus cells but were infertile and therefore could substitute for synthetic hyaluronidase. The outcomes of PESA-IVF with rescue ICSI were equivalent to PESA-ICSI. Using spermatozoa obtained by PESA and IVF before RE-ICIS is a viable treatment for men with OA.

PMID:
23989999
[PubMed - indexed for MEDLINE]
PMCID:
PMC3800539
Free PMC Article
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