Received May 22, 2024
Accepted November 25, 2024

Objective: To study the reliability and effectiveness of the percutaneous sperm retrieval technique. Materials and Methods: We retrospectively analyzed the records of 123 consecutive patients with obstructive azoospermia who underwent percutaneous sperm retrieval and intracytoplasmic sperm injection (ICSI) using Percutaneous Epididymal Sperm Aspiration (PESA) with or without a rescue Testicular Sperm Aspiration (TESA). We compared patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed. In addition, the rate of adequate sperm retrieved for ICSI and reproductive outcomes between the groups and literature were compared. The primary outcome was the rate of adequate sperm retrieved for ICSI; the secondary outcomes were reproductive. Results: The successful sperm retrieval was 157 in 157 attempts, with a cumulative sperm retrieval rate of 100%, whether the first or repeated retrieval attempt. The clinical pregnancy rate in patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed was 36/108 (33.3%) vs. 15/29 (51.7%) (Pearson chi2(1) = 3.3088; p= 0.085), respectively. Other reproductive outcomes (fertilization rate, cleavage rate, and biochemical pregnancy) were also similar in both groups. Conclusion: PESA associated with or without rescue TESA is a reliable and effective strategy either for retrieving sperm for ICSI, demystifying the concerns about the reliability of repeated PESA, or for reproductive results. This information is reassuring, especially but not exclusively to places with limited resources.