Recent concepts in the management of infertility because of non-obstructive azoospermia

Testicular biopsy has been widely used for the diagnosis of male infertility. Since the introduction of intracytoplasmic sperm injection (ICSI), spermatozoa recovered from a testicular biopsy specimen can be successfully used for establishing pregnancies. A few spermatozoa may be recovered from a wet preparation of a testicular biopsy, not only in obstructive azoospermic patients, but also in many patients with non-obstructive azoospermia. In 36 out of 38 non-obstructive azoospermic patients sperm cells were recovered from a testicular biopsy specimen. However in two patients, spermatozoa could not be found after further preparation of the biopsy specimens for ICSI. In the remaining 32 patients, a normal fertilization rate of 56.8% per successfully injected oocyte was obtained after ICSI of testicular spermatozoa. In 84% of patients, embryos were replaced with an overall pregnancy rate of 28.9% per testicular biopsy or 34.3% per embryo transfer. The results clearly indicate that at present an excisional testicular biopsy should be offered to all azoospermic patient, irrespective of concentration of follicle stimulating hormone, testicular size or medical history.