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

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.