New therapeutic possibilities handling residual azoospermia

Obviously, medical therapy of secretory azoospermia or microsurgical therapy of excretory azoospermia are not always successful. The unsolvable cases therefore can be grouped as residual azoospermias. Both the medical and microsurgical approaches are reviewed and their success rates analyzed. Some problems are unsolvable after work-up of the diagnosis. Till the early nineties, such patients were discouraged to undergo further medical therapeutic approaches and were advised to consider either adoption or donor insemination. At the present time, new possibilities have risen since the use of epididymal spermatozoa for performing assisted fertilization has considerably altered the picture. Furthermore, the last breakthrough of using testicular spermatozoa combined with the ICSI procedures have offered solutions that were unthinkable only a few years ago. The impact of these new approaches is discussed and the future development of microsurgery versus assisted reproduction techniques is also considered.