Azoospermia: Surgical Sperm Retrieval
Recent advances in techniques for surgical sperm retrieval and the advent of intracytoplasmic sperm injection (ICSI) allow for biological paternity in azoospermic men for whom the only available treatments a mere 20 years ago were use of donor sperm or adoption. Many procedures are available with which sperm may be retrieved from the epididymis and testis. These procedures vary significantly in efficacy, invasiveness, requirement for technical expertise, and indication. Informed procedure selection and proper technical performance are critical for achievement of optimal reproductive outcomes. The least traumatic method that yields sufficient high quality sperm to meet the couple’s immediate and future reproductive goals should be selected. Communication with the reproductive endocrinologist is critically important for delivery of optimal care to the couple. Sperm retrieval may either be performed electively with cryopreservation of retrieved sperm for ICSI to be performed at a later date (frozen approach), or it can be coordinated so that fresh sperm are available immediately following oocyte retrieval (fresh approach). The frozen approach has significant logistical advantages and is the preferred approach by most experts for men with obstructive azoospermia, in whom an abundance of sperm are anticipated to be retrieved. Expert consensus varies when the patient has nonobstructive azoospermia. The literature suggests that fertilization rates and pregnancy outcomes of ICSI cycles using cryopreserved sperm are at least equivalent to outcomes in cycles using fresh sperm. However, there is a theoretical chance that no viable sperm will survive the freeze-thaw process, especially when very few sperm are retrieved.
KeywordsTunica Albuginea Testicular Sperm Cryopreserved Sperm Sperm Retrieval Obstructive Azoospermia
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