Objective: To assess and discuss the fertilization, cleavage and pregnancies usinG testicular sperm in combİnation with Intracytoplasmic sperm injection (IcsI).

Materials and Methods: Fourty -seven infertile couples with obstructive and non-obstructive azoospermia and totally immotilespermatozoa in their ejeculate were included in this study. Testicular sperm extraction (TESE) were performed in 18 obstructive azoosgermic cases where microsurgical sperm aspiration or percutaneous sperm aspiration was impossible due to totally destroyed epididymis and in 24 non-obstructive azoospermic cases where the testicles were the only source of sperm cells and in 5 cases with totally or initially immotile spermatozoa with 0% or 0.1% motile sperm before and after percoll gradient in their ejaculated sample.

Results: A total of 406oocytes were retrived from 47 females and 344 (%84.7%) of them were injected (Metafaz-II). The fertilization rate with 2 pronuclei was 53.5% and the cleavage rate was 94%. However no fertilization was observed in 160 (46.5%) of injectedoocytes. The fertilization rate in obstructive group (65%) was significantly higher than in non-obstructive group (42.7%) (p<0.001). Seven cases resulted in total fertilization failure. A total of 173 embryos were obtained and 138 of them were trasferred. Nineteen pregnancies were achieved in total. 9 from obstructive and 9 from non-obstructive group. Only one pregnancy was achieved in totally immotile sperm group. Seven pregnancies (36.7%) resulted in abortion. The rates of overall pregnancy, clinical pregnancy and ongoing pregnancy per embryo transfer were 47.5%, 37.5% and 30% respectively. Three sets of triplets, two sets of twins and 10 singletons were achieved. All triple pregnancies were reduced to twin pregnancies and amniocentesis was applied in all cases. 5 healty babies were achieved from three patients delivered to date.

Conclusion: High implantation and pregnancy rates can be achieved in the treatment of

cases with obstructive and non-obstructive azoospermia using testicular sperm in combination with ICSI. Further studies are needed to confirm the place of TESE and ICSI in the totally immotile sperm group.

Key Words: Testicular sperm extraction, Intracytoplasmic sperm inlection, Obstructive azoospermia, Nonobstructive azospermia, Totally immotile sperm.