The management of azoospermia

The ability to treat azoospermic men to become genetic fathers of children represents one of the most dramatic revolutions that have occurred in the field of infertility treatment during the past two decades. Use of donor sperm is no longer the first and only treatment option in these cases. The discovery that one may use a single sperm cell and achieve normal embryos, pregnancy, and delivery after assisted fertilization by intracytoplasmic sperm injection (ICSI) changed many of the previous axiomas in the field of andrology (Palermo et al., 1992; Van Steirteghem et al., 1993). For men with no sperm in the ejaculate, surgical retrieval of sperm cells from the epididymis or testicular seminiferous tubules in combination with ICSI opened new avenues for fulfilling their fatherhood. Development of methods for surgical sperm retrieval (ssr), The first to be treated were patients with obstructive azoospermia (OA), where viable spermatozoa were retrieved from the testis with testicular sperm extraction (TESE) or testicular biopsy and used for ICSI (Craft et al., 1993; Schoysman et al., 1993a, b; Devroey et al., 1994; Nagy et al., 1995; Abuzeid et al., 1995; Silber et al., 1995a, b, c; Tucker et al., 1995) or epididymal sperm retrieval by an open surgery aimed at the epididymis named microepididymal sperm aspiration (MESA) (Temple-Smith et al., 1985; Silber et al., 1994; Tournaye et al., 1994).