Outcome of repeated testicular sperm extraction and ICSI in patients with non-obstructive azoospermia

Objective: To evaluate the outcome of repeated TESE/ICSI, in patients with non-obstructive azoospermia, to collect sufficient information for adequate counseling of the patients.
Design: Retrospective study
Setting:The Egyptian IVF-ET center
Materials and Methods: 41 patients suffering from non-obstructive azoospermia underwent 59 repeated TESE/ICSI cycles. All of the patients had repeated TESE/ICSI because of failure to achieve pregnancy (n=30), previous abortion (n=3), or because they wanted another child (n=8). Eleven patients repeated the procedure more than once. At each procedure multiple small biopsies were taken from each testicle. The interval between the repetitions of TESE was at least six months.
Main Outcome Measures: Sperm retrieval rate in each repeated trial, and the clinical pregnancy rate per ICSI cycle
Results: During repeated TESE, the mean sperm retrieval rate was 91.5%. Patients were divided into two groups according to previous pregnancy in the first trial. In group 1, (n = 11) pregnancy occurred in the first trial. They underwent 16 TESE/ICSI repeated cycles. Of these, 9 of them became pregnant a second time (PR 56.3 %). On the other hand the 30 patients who had failed to achieve pregnancy in the first trial (Group 2), underwent 43 repeated cycles. Of these only 7 became pregnant in the following trials (16.3 %). This difference is statistically significant (χ² 9.59, P< 0.05).
Conclusion: In patients with non-obstructive azoospermia, when spermatozoa were retrieved in the first TESE/ICSI cycle, the sperm recovery rate during repeated TESE trials is quite high in our study (91.5%). Previous pregnancy is a good prediction for a second pregnancy in the subsequent trials.