Intracytoplasmic sperm injection with microsurgically retrieved spermatozoa in azoospermic men infected with human immunodeficiency virus 1 or hepatitis C virus: the EP43 AZONECO ANRS study.

OBJECTIVE: To evaluate the viral contamination of sperm obtained after testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA) in men with azoospermia and human immunodeficiency virus (HIV) or hepatitis C virus infection.

DESIGN: Prospective study.

SETTING: Fertility clinic, and reproductive technology and virology laboratories.

PATIENT(S): Six men with azoospermia: two HIV-1 infected with undetectable blood viral load and four HCV infected with detectable blood viral load.

INTERVENTION(S): Processing by gradients density centrifugation and washing of surgically recovered sperm (TESE and MESA); virological analysis; in vitro fertilization with intracytoplasmic sperm injection (ICSI).

MAIN OUTCOME MEASURE(S): Detection of HIV-1 RNA or HCV RNA in gradient supernatants, testis tissues and final processed spermatozoa, and of HIV-1 DNA in testis tissues.

RESULT(S): Gradient supernatants and testis tissues tested HCV RNA positive in all cases while processed spermatozoa always tested negative. Gradient supernatants, testis tissues, and processed spermatozoa tested HIV-1 RNA negative. HIV-1 DNA was detectable in one testis tissue. All female partners tested HCV or HIV negative after ICSI.

CONCLUSION(S): Density gradient and washing suppressed virus detection in final suspensions of testicular and epididymal spermatozoa. ICSI after MESA or TESE appears to be feasible and could be offered in azoospermic men infected by HCV or HIV.