CODE: 14 - 10 years of percutaneous sperm obtaining procedures for assisted reproductive techniques IVF-ICSI/PESA,TESA
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Jan Karol Wolski, Katarzyna Kozioł, Piotr Lewandowski, Bogdan Biarda, Hanna Marszał, Sylwia Trubacz

Przychodnia "Novum" w Warszawie

summary

Introduction. First micromanipulation, in vitro fertilization (IVF) procedure during which single sperm is injected into single oocyte under microscope (ICSI Intracytoplasmic Sperm Injection), was done in 1992. It was a milestone in assisted reproductive techniques (ART). ICSI helps infertile couples with dominant male factor (advanced OAT, cryptozoospermia) to have a child. In Poland, first ICSI was done in January 1995, in Novum Infertility Center. Next, in the same clinic, first micromanipulation with sperm obtained percutaneously from epididymis (PESA, Percutaneous Sperm Aspiration) was performed in April 1996 and first procedure with sperm obtained percutaneously from testis (TESA, Testicular Sperm Aspiration) was done in September 1996. During 26th Congress of Polish Urological Association, Poznań Sept.1996, we presented first experience with ICSI-PESA procedure ended with pregnancy [1].

Objectives. This report presents our 10-years experience in percutaneous sperm obtaining for ICSI procedures.

Materials and methods. Men (mean age 32 y.o.) from infertile couples were qualified for sperm retrieval procedures: with obstructive azoospermia (OA) from epididymis and with non-obstructive azoospermia (NOA) from testis. All obtaining procedures were done ambulatory, under general anesthesia (short IV: Propofol and Fentanyl). Both epididymides were percutaneously punctured with syringe 2 mL with fine needle No 5 and aspirated liquid was examined under light microscope for sperm presence (PESA). Testicular tissue from both testes was obtained with 1.6 mm needle from Hepafix(R) set, B.Braun, Melsungen, Germany (TESA). Since 1999, during diagnostic testicular biopsy, scheduled cryopreservation of epididymal liquid and part of testicular tissue were done (the second part was fixed in Bouin's solution for routine histological evaluation). This procedure made possible to avoid next testicular biopsies before future ICSI. Mean time of procedure was 10-15 minutes. After 1-2 hours of observation each patient was verified by anesthesiologist and urologist and left the center. During postoperative time common analgesic drugs (e.g. Paracetamol) and scrotal ice compresses for 2-3 days were applied; no antibiotics were used as a rule.

Results. During 1996-2005, 74 pregnancies after micromanipulation using epididymal (PESA) and 57 after testicular (TESA) sperm were ascertained. Final results were stated by parents' declarations up to the end of 2005, which were incomplete unfortunately. ICSI-PESA group: 48 healthy children, including 10 twins (26 delivery by cesarean section, 12 spontaneous delivery), birth weight 2070-4230 g (single) and 1720-2860 g (twins). Spontaneous abortions or pregnancy terminations were reported in 9 women. ICSI-TESA group: 35 healthy children, including 12 twins (19 delivery by cesarean section, 16 spontaneous delivery), birth weight 2250-4130 g (single) and 1810-2580 g (twins). Spontaneous abortions or pregnancy terminations were reported by 7 women. No important complications after sperm obtaining in men from both groups and no prolonged breaks in life activity (work, study and sex) were reported.

Conclusions. Application of sperm obtained from epididymides and testes in micromanipulation procedures IVF/ICSI-PESA, TESA makes possible to be fathered for men with obstructive and non-obstructive azoospermia. Percutaneous sperm obtaining is non-complicated, safe, relatively cheap minimal invasive procedure.