A study to determine the fertility rates of men with congenital and acquired vasal obstruction following the use of three sperm retrieval techniques

INTRODUCTION AND OBJECTIVE: The aim was to investigate the ICSI outcomes in male patients with post-testicular azoospermia who had either CBAVD or had a previous vasectomy. We also examined three sperm retrieval techniques, PESA, MESA and TESE and assessed whether any of the techniques influenced the ICSI outcome.

MATERIALS AND METHOD: A retrospective review of data between 10th January 2008 and 11th August 2011 of couples with men having either obstructive azoospermia secondary to CBAVD or vasectomy. The sperm extraction method, age of female partner and ICSI outcome for each couple were noted and analyzed.

RESULTS – Thirty couples identified where the male partner had an obstructive azoospermia; 12 due to CBAVD and 18 having had a vasectomy. Overall the positive ICSI outcomes for CBAVD and vasectomies were 43.7% and 56.3% respectively. The success rates for couples with women under 35 were 50% for CBAVD and 75% for previous vasectomy. For women above 35 years the rates were lower at 37.5% for vasectomies only. There were no positive ICSI outcomes for couples with CBAVD above 35 years. Fertilization rates between CBAVD and vasectomies were similar and did not statistically differ.

Fertilization rates for MESA, PESA and TESE were 37.5%, 56.3% and 6.3% respectively with PESA being the most common and successful extraction method.

Using binary logistic regression and combining the type of post-testicular azoospermia and method of extraction on fertility rates the results showed no statistical difference in outcomes.

CONCLUSIONS – Overall positive ICSI outcomes were above the national average for each age bracket in our unit. Fertility rates were similar for CBAVD and previous vasectomies irrespective of the sperm extraction method. There were no significant differences in sperm extraction methods.