Outcome of Surgical Sperm Retrieval (SSR) followed by

ICSI in men with obstructive azoospermia

University of AberdeenAssisted reproductive unit

D.Giannaris, S.Bhattacharya, M.Hamilton

Obstructive azoospermiaTypical features

Vasectomy and failed reversal surgery

CAVD

Other cases

- Normal karyotype

- Normal FSH (<14)

- Normal testicular biopsy

- Testicular size

STUDY GROUPS

• Group A: Failed reversal vasectomy (n=83)• Group B: CAVD (n=16)• Group C: Obstruction of other causes (n=33)

12 patients with non-obstructive azoospermia

4

S.S.R results

Total No

n

Sperm

Retrieved n %

Group A n=83 n=83 100%

Group B n=16 n=15 94%

Group C n=33 n=29 88%

Total Motile Sperm Retrieved

0

1

2

3

4

5

Motile sperm(Median ( M))

*

* (p = 0.002)

Number of straws prepared

0

1

2

3

4

5

6

7

8

9

rev.vasectomy CAVD obst.azoosp.

Mean no of straws

(p = 0.001)

No of follicles aspirated in IVF

0

4

8

12

16

20

rev.vasectomy CAVD obstr.azoospermia

No of follicles(NS)

Nos. of eggs obtained at IVF

0

4

8

12

16

20

rev.vasectomy CAVD obstr.azoosp.

Mean nos of eggs

(NS)

Nos. of eggs fertilised

0

1

2

3

4

5

6

7

8

9

10

rev.vasectomy CAVD obstr.azoosp.

Eggs fertilised

(NS)

Fertilisation rate at IVF

0

20

40

60

80

100

rev.vasectomy CAVD obstr.azoospermia

% eggs fertilised

(NS)

Nos. of embryos transferred

0

0.5

1

1.5

2

2.5

3

rev.vasectomy CAVD obstr.azoosp.

Embryos transferred

(NS)

Implantation Rate

0

5

10

15

20

25

30

35

rev.vasectomy CAVD obstr.azoosp.

% Sacs/Embryos transferred

(NS)

Live births & ongoing pregnancies

0

5

10

15

20

25

30

35

40

rev.vasectomy CAVD obstr.azoosp.

% per cycle

started(NS)

Patient & treatment profiles(Pregnant vs Non-pregnant)

No differences in:• embryos grade• embryos stage• male age• female age• 1y vs 2y female

infertility• male smoking• female smoking

Statistical significant difference in:

• female pathology

Conclusions

• S.S.R is effective in obstructive azoospermia.• Failed vasectomy reversal group have the best

prognosis.• Cases other than vasectomy reversal or CAVD were

associated with fewer motile sperm, lower implantation rate and lower live birth rate.

• Few numbers to demonstrate statistical significance.