Natural spermatoceles in irreversible obstructive azoospermia--reservoirs of viable spermatozoa for assisted conception.

Fine needle aspiration of asymptomatic spermatoceles detected in five men with obstructive azoospermia was evaluated as a minimally invasive method of sperm retrieval for assisted conception. Sperm preparations adequate for in-vitro fertilization were initially obtained from three men, but there was failure of fertilization in all three cycles. However, intracytoplasmic sperm injection (ICSI) in three couples resulted in fertilization of 58% of metaphase II oocytes, with embryo transfers in five of six cycles. A successful pregnancy and delivery resulted from spermatozoa from a man with an irreversible vasectomy, for whom previous epididymal microaspiration and ICSI had been unsuccessful. Spermatoceles were found in 4% of men with irreversible obstructive azoospermia referred for assisted conception. These patients should therefore be examined very carefully for small cysts near the epididymis, because fine needle aspiration, usually without anaesthesia, can instantly locate a ready source of viable spermatozoa for ICSI. This is less invasive than the alternative sperm retrieval procedures, which are more traumatic and require local or general anaesthesia.