Pregnancy in an azoospermic patient with markedly elevated serum follicle-stimulating hormone levels.

OBJECTIVE

To assess the possibility of achieving a pregnancy in an azoospermic patient with markedly elevated serum FSH level.

DESIGN

A case report.

SETTING

In vitro fertilization program at the Instituto Valenciano de Infertilidad.

PATIENT

An azoospermic patient with small testes and serum FSH level (38.7 mIU/mL) higher than three times normal. Testicular biopsy revealed Sertoli cell-only syndrome with focal spermatogenesis.

INTERVENTIONS

Intracytoplasmic microinjection of testicular tissue-extracted spermatozoa.

MAIN OUTCOME MEASUREMENTS

Fertilization rate, cleavage rate, clinical pregnancy.

RESULTS

Eight of 11 (73%) intact oocytes showed two pronuclei. All of them cleaved normally. Four embryos were replaced into the uterine cavity and the other four were cryopreserved. A twin clinical pregnancy was achieved.

CONCLUSION

Spermatozoa may be present in testicular biopsy specimens of azoospermic patients with severe spermatogenic failure despite markedly elevated serum FSH level. These patients can be fertile after intracytoplasmic testicular sperm microinjection.