RECENT CONCEPTS IN THE MANAGEMENT OF INFERTILITY BECAUSE OF NONOBSTRUCTIVE AZOOSPERMIA

Testicular biopsy has been widely used for the diagnosis of male infer tility. Since the introduction of intracytoplasmic sperm injection (IC SI), spermatozoa recovered from a testicular biopsy specimen can be su ccessfully 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 nonob structive azoospermia, In 36 out of 38 nonobstructive azoospermic pati ents sperm cells were recovered from a testicular biopsy specimen. How ever in two patients, spermatozoa could not be found after further pre paration of the biopsy specimens for ICSI, In the remaining 32 patient s, a normal fertilization rate of 56.8 % per succesfully injected oocy te was obtained after ICSI of testicular spermatozoa. In 84% of patien ts, embryos were replaced with an overall pregnancy rate of 28.9% per testicular biopsy or 34.3% per embryo transfer, The results clearly in dicate that at present an excisional testicular biopsy should be offer ed to all azoospermic patient, irrespective of concentration of follic le stimulating hormone, testicular size or medical history.