【Objective】 To evaluate the pregnancy outcomes of intracytoplasmic sperm injection (ICSI) with sperm obtained by surgical sperm retrieval in the men with ejaculation failure on the day of oocyte retrieval and to find out the protocol in case of ejaculation failure. 【Methods】 Retrospectively analyze 33 cases in our IVF center who had ejaculation failure on the day of oocyte retrieval and underwent surgical sperm retrieval combining with ICSI from May 1

2005 to May 1

2009. They were divided into percutaneous epididymal aspiration (PESA) group and testicular sperm extraction (TESE) group (28 cases). The fertilization rate

cleavage rate

good quality embryos rate

pregnancy rate and implantation rate between the two groups were compared after ICSI.【Results】 In the past five years

ejaculation failure occurred in 0.52% (33/6341) on the day of oocyte retrieval retrievals in our unit. All the 33 patients could retrieve sperm with surgical method successfully

including 5 cases from PESA (15.2%

5/33) and 28 cases from TESE (84.8%

28/33). There were no statistically difference between the two groups in fertilization rate (69.2% vs. 78.6%

P = 0.118)

pregnancy rate (60.0% vs 37.0%

P = 0.374) and implantation rate (41.7% vs 21.2%

P = 0.129). But there were statistically significant difference between the cleavage rate (88.9% vs 99.7%

P = 0.019) and good quality embryos rate (52.5% vs 75.6%

P = 0.004) between the two group. Thirty-two cycles had fresh embryo transfer

only one cycle had no embryo transfer due to no fertilization after ICSI. The biochemical pregnancy rate and implantation rate were 40.6% (13/32) and 24.4% (19/78)

respectively. Fourteen babies were born. 【Conclusion】 Surgical sperm retrieval combining with ICSI is an effective solution for those men with ejaculation failure on the day of oocyte retrieval. It could avoid cancellation of treatment cycles.