Comparison of Intracytoplasmic Sperm Injection Outcomes between Obstructive Azoospermic Patients

To determine the differences in sperm quality and results of intracytoplasmic sperm injection (ICSI) cycles between three groups of male factor infertile couples: oligozoospermic, obstructive azoospermic and non-obstructive azoospermic. In this prospective cohort study, 628 male factor infertile couples who underwent ICSI cycles from April 2004 to March 2006 were enrolled. Three hundred fourteen oligozoospermic patients (group I), 180 obstructive azoospermic patients (group II) and 134 non-obstructive azoospermic patients (group III) were included. Fertilization, cleavage, implantation and clinical pregnancy, early abortion rates were assessed. Chisquare and analysis of variances with Post Hoc (Tukey test) were used for data analysis. Fertilization rates were significantly different in the three groups (group I: 66.6%; group II: 51.8%; group III: 47.7%; p=0.004). There were differences in the implantation rates (I: 19.5%; II: 17.6%; III: 6.4%; p=0.001). The cleavage rates were found to be 55.1% (group I), 47.5% (group II), 45.5%(group III), respectively. The clinical pregnancy rate was the lowest in the third group (I: 37.6%; II: 28.9%; III: 13.4%; p=0.001). There was no significant difference in early abortion rates between the three groups: (I: 10.7%; II: 9.8%; III: 8%; p=0.776). It can be concluded that patients with oligozoospermia may benefit the most from ICSI treatment. ICSI cycles which use spermatozoa from non-obstructive azoospermic patients have a lower chance for successful outcome. The results of this study suggest, in cases of failure to achieve pregnancy after 1 or 2 cycles in non-obstructive azoospermic patients, embryo donation would be a better alternative.