ICSI with Epididymal and Testicular Sperm Retrieval

Abstract

Silber et al. and Tournaye et al. initially developed the use of intracytoplas-mic sperm injection (ICSI) to treat obstructive azoospermia due to congenital absence of the vas deferens (CAV), failed vasopepididymostomy (V-E), and otherwise irreparable obstruction, using microsurgically retrieved epididymal sperm (1,2). We coined this procedure “MESA” (i.e., microsurgical epididymal sperm aspiration). Devroey et al., Silber et al., and Schoysman et al. then demonstrated the systematic use of ICSI with testicular sperm in cases where there is either no epididymis or no motile sperm in the epididymis (3–5). Several months later, Devroey et al. and Silber et al. demonstrated that intracytoplasmic sperm injection using frozen-thawed epididymal spermatozoa retrieved from a previous attempt at fresh MESA was as successful as using freshly retrieved sperm (4,6). The present state-of-the-art appears to be that there are very few cases of obstructive azoospermia that cannot be successfully treated with sperm retrieval methods and ICSI, as long as the wife has adequate eggs (7). This may involve the use of epididymal sperm, or, if epididymal sperm cannot be retrieved, the use of testicular sperm.