Intracytoplasmic Sperm Injection Outcomes Using Epididymal Sperm Obtained by Percutaneous Aspiration: An 11-Year Single-Center Experience.

Abstract

Objectives: Percutaneous epididymal sperm aspiration (PESA) is a minimally invasive surgical sperm retrieval technique used in patients unable to provide ejaculated spermatozoa. This study aimed to evaluate fertilization, clinical pregnancy, and live birth outcomes following intracytoplasmic sperm injection (ICSI) using epididymal sperm obtained via PESA over an 11-year period at a single tertiary referral center.

Methods: This retrospective cohort study analyzed 63 PESA-ICSI cycles performed in 46 male patients between January 2015 and December 2025. Indications for PESA included obstructive azoospermia (n=13 cycles) and medically refractory ejaculatory dysfunction (n=50 cycles). Outcomes were evaluated both at the cycle level and independently per embryo transfer (ET) procedure. Comparative analyses were performed according to PESA indication, embryo developmental stage at transfer, and transfer type.

Results: Sperm retrieval was completely successful in all 63 cycles (100%). Of 498 mature (MII) oocytes injected, normal fertilization (2PN) was achieved in 268, yielding an oocyte-level fertilization rate of 53.8%. Total fertilization failure occurred in only one cycle (1.6%). Embryo transfer was performed in 57 cycles, resulting in 68 individual transfer procedures (42 fresh and 26 frozen-thawed). The overall clinical pregnancy rate was 39.7% (25/63) per initiated cycle and 36.8% (25/68) per ET procedure. The overall live birth rate was 33.3% (21/63) per initiated cycle and 30.9% (21/68) per ET procedure. No statistically significant differences were observed between cleavage-stage and blastocyst-stage transfers with respect to clinical pregnancy (p=0.615) or live birth outcomes (p=1.000). No major procedural complications were recorded.

Conclusion: PESA combined with ICSI provides favorable reproductive outcomes with a low rate of total fertilization failure. These results were achieved despite a cohort characterized by diminished ovarian reserve and diverse male infertility etiologies. The high sperm retrieval success rate and consistent clinical outcomes support PESA as a reliable and effective sperm retrieval technique in contemporary assisted reproductive practice.