[Intacytoplasmic sperm injection: reproductive reality in couples with sterility].

BACKGROUND

The intacytoplasmic sperm injection (ICSI) is the assisted reproduction technique (ART) that currently offers satisfactory results to infertile couples. The use of epididymal surgical retrieval (percutanean epydidimal sperm aspiration: PESA) and testicular sperm retrieval (testicular sperm extraction: TESE) combined with ICSI has come to bring a high response to azoospermic male.

OBJECTIVE

To communicate the results obtained from the Institute for the Study of Human Conception, in Monterrey, NL, with the application of the ICSI technique with ejaculate sperm and in azoospermic patients using sperm obtained from PESAor by testicular sperm extraction TESE.

METHODS

From January 1999 to December 2003 1,436 couples were studied at the Institute for the Study of Human Conception, Monterrey, Mexico; 729 cases underwent to ICSI (50.8%), 670 used the ejaculate sperm, in 37 cases (5%) PESA and 22 cases (3%) TESE. These patients were treated as usual: controlled ovarian hyperstimulation (COH) with FSHr alone or combined with HMG or LHr, use of GnRH analogs (agonist o antagonist), follicular monitoring up to the presence of 3 follicles longer than 18 mm; ovular retrieval 34 h after HGC application and embryo transfer in days 3 or 5 of development.

RESULTS

No statistically significant difference was noted in the woman's age (p = 0.623), type and time of sterility (p = 0.446, 0.150), neither in FSH, LH and estradiol levels (p = 0.549, 0.623, 0.685). The middle age of the male had significant difference between PESA (38.9 +/- 7.3) and ejaculated sperm (36.1 +/- 6.4) (p = 0-024). The pregnancy rates among groups of the ejaculate sperm, PESA and TESE were 32.8%, 43.2% and 40.9% respectively, without significant difference (p = 0.327), neither in implantation rates: 11.2%, 26% and 11%, respectively (p = 0.153).

CONCLUSIONS

The technique of ICSI and use of PESA and TESE offer satisfactory results in infertile couples, including azoospermic male.