ABSTRACT
In the past 10-20 years, several changes have taken place in clinical andrology. Gradually, empirical treatments have been replaced by techniques of assisted reproduction – intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Especially the introduction of ICSI in 1992 (1,2) has completely changed the clinical approach toward male infertility by offering a novel opportunity for parenthood to azoospermic men. A single spermatozoon can be injected into an oocyte and result in normal fertilization, embryonic development, and implantation. Not only ejaculated spermatozoa can be used; epididymal or testicular spermatozoa too can be used for ICSI. Testicular spermatozoa can be retrieved in some patients with nonobstructive azoospermia (NOA) because of the persistence of isolated foci of active spermatogenesis. The fi rst pregnancies using epididymal and testicular spermatozoa in men with obstructive azoospermia (OA) and NOA were published in 1993 and 1995, respectively (3-6). Surgical retrieval of spermatozoa for ICSI has currently become a routine technique in clinical andrology. Several techniques are available to retrieve epididymal or testicular spermatozoa. Although there is no real method of choice, some guidelines may be given to make the best choice for a specifi c clinical setting. ICSI has also reinforced the role of nonsurgical techniques to retrieve sperm in men suffering from anejaculation.
