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Korean Journal of Fertility and Sterility 2003;30(2):119-126.
Published online June 1, 2003.
The Study on Comparison of Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Epididymal Sperm and Testicular Sperm.
Ki Cheong Sung, Moon Joo Kang, Hee Sun Kim, Sun Kyung Oh, Seung Yup Ku, Chang Suk Suh, Seok Hyun Kim, Young Min Choi, Jung Gu Kim, Shin Yong Moon
1Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea.
2Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea.
This study was carried out to compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia according to sperm retrieval site and technique; microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction by open biopsy (TESE). METHODS: The outcomes of ICSI and IVF-ET were evaluated and compared among 3 groups. Seventy three men suffering from infertility due to obstructive azoospermia had 107 ICSI cycles using MESA (21 cycles in 15 patients), PESA (26 cycles in 17 patients) and TESE (60 cycles in 41 patients). RESULTS: In the clinical outcomes in patients undergoing ICSI with epididymal or testicular sperm, there were no significant differences in fertilization rate (66.1% vs. 60.5%), cleavage rate (94.9% vs. 97.6%), cumulative embryo score (CES) (51.3 vs. 58.8), implantation rate (7.9% vs. 6.1), and clinical pregnancy rate per ET (30.4% (14/46) vs. 25.4% (15/59)) between both groups. Also, in the clinical outcomes in ICSI patients using MESA, PESA, TESE, there were no significant differences in fertilization rate (61.8%, 69.4%, 60.5%), cleavage rate (92.1%, 97.3%, 97.6%), CES (38.1, 52.0, 58.8), implantation rate (9.5%, 6.6%, 6.1%), and clinical pregnancy rate per ET (35% (7/20), 26.9% (7/26), 25.4% (15/59)) among 3 groups. CONCLUSION: When compared with MESA or TESE, PESA, the clinical outcomes were similar in ICSI patients with obstructive azoospermia whatever the origin or the technique of sperm retrieval. However, we considered PESA is more time-saving and cost effective for ICSI in patients with obstructive azoospermia.
Key Words: Obstructive azoospermia, microsurgical epididymal sperm aspiration (MESA); Percutaneous epididymal sperm aspiration (PESA); Testicular sperm extraction by open biopsy (TESE); Intracytoplasmic sperm injection (ICSI)


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