Table 1.
Studies reporting sperm retrieval efficacy and/or pregnancy outcomes in men with obstructive azoospermia.
| Author | Country | Design | No. of cycles | Mean Paternal Age (years) | Outcome | Main findings | Conclusion |
| Rosenlund et al. 1998 | Sweden | Retrospective | NR | 37 | Recovery of viable sperm on repeated PESA | High sperm recovery rates were found on repeated PESA up to 4 times | PESA is simple, offers a high sperm recovery rate and can be safely repeated in OA men, yielding similar SRR results. |
| Levine et al. 1998 | USA | Retrospective | 37 | NR | Efficacy and safety of percutaneous sperm retrieval and ICSI outcomes (CPR) using retrieved sperm | Efficacy and safety of percutaneous sperm retrieval techniques (PESA, TESA) were demonstrated | PESA and TESA are more effective alternatives compared with the more invasive MESA approach. |
| Dohle et al. 1998 | The Netherlands | Retrospective | 39 | 38.1 | ICSI outcomes (ongoing pregnancy rates) using percutaneously or surgically-retrieved sperm | Both percutaneously and surgically retrieved spermatozoa provide adequate pregnancy outcomes. | High fertilization rate was obtained after ICSI regardless of the retrieval method |
| Janzen et al. 2000 | USA | Retrospective | 108 | 38.3 | ICSI outcomes (CPR) using fresh or frozen epididymal sperm | Both fresh and cryo-thawed epididymal sperm harvested by MESA yielded similar CPR | Comparable pregnancy outcomes for fresh and frozen epididymal sperm, with logistic-related advantages for frozen sperm |
| Glina et al. 2003 | Brazil | Retrospective | 79 | 45 | Success at obtaining sperm by PESA and CPR after ICSI | High SRR on repeated PESA up to 4 times | PESA is simple, offers a high sperm retrieval rate and can be safely repeated in men with OA. |
| Westlander et al. 2001 | Sweden | Retrospective | 22 | 34.8 | ICSI outcomes up to ongoing pregnancy/delivery rates after TESA | TESA can be repeated with no negative impact on the recovery of mature spermatozoa or pregnancy outcome | Repeated TESA is safe and effective |
| Levine et al. 2003 | USA | Retrospective | 112 | 37.1 | ICSI outcomes (CPR) after percutaneous sperm retrieval | PESA and TESA are highly effective for sperm retrieval and offer similar pregnancy outcomes with ICSI. | Percutaneous sperm aspiration is effective, safe and reproducible |
| Dozortsev et al. 2006 | Brazil | Retrospective | 185 | NR | ICSI outcomes (ongoing pregnancy rates) with percutaneous sperm retrieval | Higher FR in the PESA group and higher implantation rate in the TESA group were reported; trends toward higher PR and lower miscarriage rate in the TESA group | Embryo development was significantly better when testicular sperm was used for ICSI |
| Pasqualotto et al. 2006 | Brazil | Retrospective | 155 | NR | ICSI outcomes according to etiology of OA | Higher FR and implantation rate in men with congenital OA; similar PR in all etiology categories | No impact of etiology of OA on CPR |
| Garg et al. 2008 | USA | Retrospective | 38 | 39.1 | ICSI outcomes (LBR) using TESA | TESA is highly effective in recovering motile spermatozoa and offers adequate pregnancy outcomes. | TESA is an effective means of recovering mature motile sperm which are suitable for cryopreservation in most cases. |
| Kamal et al. 2010 | Egypt, The Netherlands, United Kingdom | Retrospective | 1,661 | 39.2 | ICSI outcomes (CPR) according to sperm source and etiology of obstruction | Similar pregnancy outcomes for different sperm sources (testicular or epididymal) and causes of obstruction (congenital or acquired) | The source of sperm and the etiology of obstruction do not seem to influence pregnancy and miscarriage rates. |
| Kalsi et al. 2010 | United Kingdom | Retrospective | 258 | NR | ICSI outcomes (live birth rate) using fresh or frozen-thawed retrieved sperm | Higher pregnancy and live birth rates were reported for frozen-thawed compared with fresh sperm | No negative impact of using frozen-thawed epididymal or testicular sperm for ICSI; a tendency for higher PR and live birth rate associated with frozen-thawed testicular sperm |
SRR: sperm retrieval rate; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PESA: percutaneous epididymal sperm aspiration; TESA: testicular sperm aspiration; MESA: microsurgical epididymal sperm aspiration; FR: fertilization rate; PR: pregnancy rate; CPR: clinical pregnancy rate; LBR: live birth rate; NR: not reported.