A new simple technique of epididymal sperm collection for obstructive azoospermia

epididymal tubule (Figure 1c) was harvested simply by touching the base of sterilized disposable plastic dishes (60 mm in diameter), directly to the incised epididymal tubule (Figure 1d). The epididymal fluid collected in the plastic dishes was diluted with washing medium and then examined for the presence of sperm directly under an inverted phase-contrast microscope. If the sperm were not detected, MESIC was continued from the corpus to the caput epididymis until motile sperm were obtained. If the sperm were detected, sperm parameters were assessed on a hemocytometer. The retrieved sperm were then frozen in liquid N 2 at −196°C for future ICSI. Diagnostic testicular biopsy was performed in the ipsilateral testis concomitantly with MESIC but was not always necessary. The wound was closed in layers with 4-0 absorbable sutures. All surgical procedures were performed without using a surgical microscope. Macrosurgical epididymal sperm imprint collection was successfully performed with no intra-or post-operative complications in all 17 patients (100%). The mean ± s.d. of total sperm number (×10 6), sperm motility (%), and sperm viability (%) were, respectively, 21.2 ± 31.9, 33.0 ± 23.2, and 53.5 ± 25.9. All of the obtained sperm was cryopreserved for future ICSI. Our results that the success rate in obtaining epididymal sperm and the mean percent sperm motility was 100% and 33%, respectively, are comparable to those of previous reports for MESA – success rates of 80%–100% and mean percent sperm motility of 15%–42% 7,8 – suggesting that MESIC is a safe and feasible technique to retrieve epididymal sperm in patients with OA. Histopathological findings ranged from normal spermatogenesis to defective spermatogenesis with a mean Johnsen score of 8 (range, 4.7–9.0) although epididymal sperm were successfully obtained by MESIC in all patients. These results might be explained by a patchy distribution of reduced spermatogenesis due to chronic obstruction throughout the testis 9 and suggest that histopathological findings based on a single testicular biopsy are not always representative of the entire testis. Mean operative time was 41.5 min (s.d. =7.0) for MESIC alone and 11.7 min (s.d. =4.4) for additional testicular biopsy. Hospitalization period was not short with a mean of 2.8 days (s.d. =0.8). This would be ascribed to some reasons; hospitalization period and anesthesia method were primarily determined by the patients' requests and institutional guidelines: 1-day hospitalization for local anesthesia and 2 or 3 days hospitalization for spinal or general anesthesia. We believe that …