Aim:To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration(PESA)and intrauterine insemination(IUI),Methods:Ninety azoospermic patients with congenital bilateral absence of the vas deferens(BAVD，N=58）or bilateral caudal epididymal obstruction(BCEO,n=32)requesting for fine needle aspiration(FNA),PESA and IUI were recruited.The obstruction was diagnosed by vasography and determination of the fructose,carnitine and alpha-glucosidase levels in the seminal fluid.Results:The mean sperm motility,density,abnormal sperm and total sperm count of the caput epdidymis were 16%±22%,(12±31)×10^6/mL,55%±36% and (16±14)×10^6,respectively,In the 90 couples,a total of 74 PESA procedures and 66 cycles of IUI were performed.Three pregnancies resulted,including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception.The pregnancy rate per IUI cycle was 4.5%.Conclusiong:The birth of normal,healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity.The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.
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