IVF with ICSI - for Men with Azoospermia

Infertile couples with severe male factor infertility (poor sperm count, motility, or morphology) can be treated with intracytoplasmic sperm injection (ICSI). Now, even men with no sperm in the ejaculate (azoospermia), whether from obstructions or sperm production problems (non-obstructive azoospermia), may have a chance to father a biological child. 

Obstructive azoospermia

Men with obstructive azoospermia include those with congenital absence of the vas deferens, failed vasectomy reversals, and other irreparable obstructions. In these situations, the woman goes through a typical in vitro fertilization (IVF) cycle and on the day of egg retrieval, sperm are also retrieved. Sperm may also be retrieved ahead of time and frozen. Sperm can retrieved by:

1. Micro Epididymal Sperm Aspiration (MESA), a delicate surgical technique using the microscope to aspirate sperm from near the obstruction.
   
2. Percutaneous Epididymal Sperm Aspiration (PESA), in which a small needle and a local anesthetic are used to aspirate sperm from near the obstruction.
   
3. Testicular Sperm Biopsy (TESE), in which a small biopsy of testicular tissue is taken under anesthesia. TESE is most often used when no sperm are obtained with MESA or PESA.

* These procedures are done on an outpatient basis.

Sperm obtained through MESA, PESA, or TESE must be processed by an experienced IVF lab for ICSI. The sperm are injected into the mature eggs retrieved from the woman, and embryos are placed in the uterus three or five days later. These sperm fertilize well with ICSI and pregnancy and delivery rates are no different than with regular IVF. Pregnancy and delivery rates are dependent on the age of the biological mother. Epididymal sperm can be frozen for future use.

Non-obstructive azoospermia

IVF with ICSI has also been shown to be successful in men with non-obstructive azoospermia; that is, men whose testicles do not appear to produce sperm. Most patients with non-obstructive azoospermia have miniscule production of sperm by the testicles, but no sperm in their ejaculate. In approximately 50 percent of these men, an extensive testicular biopsy can yield enough sperm to perform ICSI. Even patients whose routine diagnostic testicular biopsy did not reveal sperm may yield enough sperm with a thorough search of testicular tissue. 

Fertilization, cleavage, and pregnancy rates with ICSI from men with non-obstructive azoospermia may be lower than in patients with obstructive azoospermia. Non-obstructive azoospermia probably has a genetic cause for many of these men. Azoospermia may be passed on to male offspring from IVF with ICSI.