Abstract
This study aimed to evaluate the safety and efficacy of percutaneous epididymal and testicular sperm aspiration as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperms for use in the intracytoplasmic sperm injection and the indications for performing testicular biopsy in azoospermic infertile males. Thirty married patients were included in this prospective study from February 2011 to December 2012 seen in Basrah General Hospital. Their age ranged from 20 to 40 years. All patients underwent full medical examination with laboratory tests which included seminal fluid analysis, serum leutinising hormone (LH), follicular stimulating hormone (FSH), testosterone, and prolactin in addition to color Doppler ultrasonography of the scrotum. Patients with history of undescended testes, varicocele, & testicular pathology were excluded from this study. All patients showed normal physical examination with normal secondary sexual characters. The external genitalia were normal with normal sizes of their testes. The percutaneous epididymal and testicular sperm aspirations were positive in 12 out of 30 patients (40%). The rest had negative aspirations (60%). The testicular biopsy which performed in the patients with negative aspiration showed normal germinal epithelium with mature spermatozoa in only 5 patients out of 18 (28%) while the rest 13 patients had spermatogenic arrest (72%). In conclusion, percutaneous epididymal and testicular sperm aspiration has been found helpful as a diagnostic technique for patients with non-reconstructable azoospermia. It is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive and costly. It is less invasive than testicular biopsy and preferably performed as a first step procedure in an attempt to obtain sperms for both diagnostic and therapeutic purposes.
Highlights
Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year[1]
Aim of the study The aim of this study is to evaluate the *safety and *efficacy of percutaneous epididymal and testicular sperm aspiration as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperms for their subsequent use in the intracytoplamic sperm injection (ICSI), and the indications for performing testicular biopsy. * Regarding post-aspiration complications * Sperm retrieval rate in comparison with the standard testicular biopsy
The first open sperm retrieval procedures such as microsurgical sperm aspiration were abandoned for less invasive techniques such as percutaneous epididymal sperm aspiration
Summary
Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year[1]. Conception is normally achieved within 12 months in 80 to 85% of couples who are not using contraceptive measures[2]. Infertility usually becomes manifest if both partners are subfertile; this explains why in infertile couples there is often a coincidence of male and female factors. In 40–60% of cases there is abnormal seminal analysis and there is no relevant history or abnormality on physical examination and endocrine laboratory testing (idiopathic male infertility)[1]
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