Epididymal sperm retrieval by epididymal micropuncture combined with intracytoplasmic sperm injection: difference between acquired and congenital irreparable obstructive azoospermia.

To evaluate the differences in fertilization and pregnancy rates following intracytoplasmic sperm injection (ICSI) of retrieved epididymal sperm between congenital (group 1) and acquired (group 2) unreconstructable obstructive azoospermic patients, we compared the outcome of the ICSI procedure between these two groups. Thirty-six patients with obstructive azoospermia received epididymal sperm retrieval by the micropuncture method for the ICSI procedure. Main parameters evaluated were epididymal fluid volume, sperm concentration, sperm-motility; fertilization rate and clinical pregnancy rate. There were no significant differences in epididymal fluid and sperm concentration between the two groups. However, the sperm motility in group 1 was significantly higher than that in group 2. The fertilization rates per couple in groups 1 and 2 were 78.2 and 82% (nonsignificant). The pregnancy rate per couple in group 1 was 37.5% (6/16), while that in group 2 was only 5% (1/20); this difference was statistically significant (p < 0.05). Using epididymal sperm for the ICSI procedure, the chances of pregnancy for couples with congenital absence of the vas deferens were significantly higher compared with couples with acquired unreconstructable obstructive male infertility.