Langzeitergebnisse der assistierten fertilisierung

Introduction: MESA (Microsurgical epididymal sperm aspiration) and TESE (testicular sperm extraction) are established methods to obtain viable sperms from subfertile patients. Here we investigated, whether the use of either fresh or frozen-thawed sperms impact on the results of assisted fertilization. Material and methods: Since 1995, 56 patients had 63 operations. In 42 cases the following ICSI (Intracytoplasmatic sperm injection) was performed with fresh (FS) and in 21 cases with frozen-thawed sperms (FTS). There was no statistical difference for age, etiology, risk factors or hormonal parameters. Results: Microscopy was performed during surgery. Normal number of sperms was seen in 45% (FS) and 47% (FTS). In 35% (FS) and 32% (FTS), respectively, only less and/or immotile sperms were seen and in 20% (FS) and 21% (FTS) of cases no sperms were found at all. Histologically, a normal spermiogenesis could be demonstrated in 20% (FS) versus 21% (FTS). A hypospermatogenesis or nearly Sertoli cell-only pattern was present in 30% (FS) and 26% (FTS) and a total Sertoli cell-only pattern was found in 20% (FS) and 32% (FTS), respectively. A maturation arrest was found in 10% (FS) and 5% (FTS). Until september 1998, 28 (FS) and 19 couples (FTS) underwent ICSI treatment. In 11 (39.3%) cases a delivery was achieved by use of fresh sperms, while with the use of frozen-thawed sperms only 3 (15.6%) babys were born. Conclusion: In our experience, the baby take home- rate was significantly higher when fresh sperms were used despite the fact that preoperative parameters were comparable in both groups. Therefore, MESA or TESE followed by ICSI with fresh sperms seems to be the more successful treatment in male infertility.