SURGICAL SPERM RETRIEVAL FOR INTRACYTOPLASMIC SPERM INJECTION

The introduction of intracytoplasmic sperm injection (ICSI) provides n ew hope for many couples suffering from the most untreatable forms of male infertility as ICSI can also be successfully pet-formed using epi didymal or testicular spermatozoa. Testicular spermatozoa may be recov ered from testicular tissue in every patient with excretory azoospermi a, but also in about half of patients with secretory azoospermia. The strongest parameter to predict successful testicular sperm recovery is histopathological examination of a testicular biopsy, especially in p atients with some form of germ-cell aplasia. Even in our series of Kli nefelter patients, testicular sperm were recovered in eight out of 15 patients and after seven ICSI cycles combined with preimplantation dia gnosis, two singletons were born. Less invasive techniques such as per cutaneous fine-needle aspiration have been introduced and may yield co mparable success rates in patients with normal testicular function. Th e high fertilization rates after testicular sperm recovery and ICSI an d the favourable implantation rates may therefore render microsurgical epididymal sperm aspiration (MESA) obsolete in the future for patient s with normal spermatogenesis. Besides, the use of cryopreserved testi cular spermatozoa may become an alternative to repeated surgery for ob taining testicular tissue for subsequent ICSI treatment cycles.