Between 1996 and 2006, 484 diagnostic testicular (TESE) or epididymal sperm extractions were performed for azoospermia or aspermia. In 109 men with non-obstructive azoospermia (NOA), 80 with obstructive azoospermia and 52 with aspermia, 504 ICSI cycles using fresh or frozen-thawed sperm were performed. Surgical anastomosis was performed in 23 men with vasoepididymal obstruction. Azoospermics due to hypogonadotrophic hypogo-nadism (HH) (n=6) and cancer treatment (n=33) benefited from gonadotrophins and ICSI and TESE-ICSI, respectively. Sperm retrieval (positive in 44% of the 333 NOA patients) depended on testicular volume, FSH and histological Johnsen score. Johnsen score influenced fertilization and pregnancy rates, number of oocytes predicted pregnancy and maternal age predicted live birth. After TESE-ICSI, 116 pregnancies were obtained resulting in 84 live births. After microsurgery, 14 (61%) men had normal sperm and 10 (43%) fathered a child. In azoospermia with HH or after cancer treatment, ICSI shortens the duration of hormonal treatment and enhances the chances of pregnancy.
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