Outcome of surgical sperm retrieval and ICSI in Iraqi azoospermic patients

Abstract

Although ICSI technique represents the cornerstone in the management of infertility worldwide, this technique was only recently introduced to our country and this might be the first prospective study of its kind that done in Iraq which tries to evaluate the outcome of surgical sperm retrieval in azoospermic Iraqi patients using different methods of surgical sperm retrieval technique and to evaluate the pregnancy rate for those patients who tried ICSI.Patients and methods:- This was a single center prospective study, which was performed at the reproductive and ICSI center, department of urology at AL-SADER MEDICAL CITY. The time of enrollment was from sixteenth of February to sixteenth of December 2011. A total of 146 azoospermic patients have been included in this study. Surgical methods which were used for sperm retrieval included PESA, TESA, simple TESE, open surgical epididymal sperm aspiration, open multiple TESE and Micro surgical TESE.Results:- The aim of our treatment is to obtain and freeze sperm sufficient for at least two ICSI cycles. The total number of patients who had met the above criteria after surgical sperm retrieval (SSR) was 92 patients out of 146 patients included in the study. The overall success rate was 63%, this including 100% success rate in obstructive azoospermia and 45% success in NOA. For those patient who try ICSI at time of this study the fertilization rate was 85% , embryo transfer was done in 75% , and the pregnancy rate was 23%.Conclusion:-Although the combination of surgical sperm retrieval (SSR) and ICSI may be the sole treatment available for male factor infertility with uncorrectable azoospermia, the overall success rate is limited particularly in NOA and ongoing pregnancies are obtained in <25% of ICSI cycles. However every azoospermic patients should offer such option of treatment and for those patients who had succeed sperm retrieval, multiple ICSI cycle trials may increase the chance of pregnancy without the need for repeated surgery. Open surgical methods of SSR, has been shown to increase the options available to the embryologist to use , select and cryopreserved sperms, however it will increase the surgical trauma to the testicles and increase the tissue extracted , the effects of these factors on the future testicular function needs to be investigated by further studies.