When Is Azoospermia Not Azoospermia?

[摘要] Men with azoospermia, defined as no sperm in the ejaculate as documented by semen analysis, either have an obstruction to the excretory ductal system or defective spermatogenesis. The observation that more than 60% of men with defective spermatogenesis may have pockets of spermatogenesis within the testis1,2 provides hope that many of these “azoospermic” patients can potentially be fathers with testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) together with intracytoplasmic sperm injection and in vitro fertilization, provided these “pockets” of sperm, which theoretically never make it out of the ductal system, can be successfully harvested. TESE in these nonobstructive azoospermic patients requires either the use of a microscope to find the sperm (micro-TESE) or multiple incision sites in 1 or both testes in the search for these pockets of sperm.3 TESA also requires multiple aspirations in these azoospermic patients, although the success rate with TESA may not be as high as with TESE.4,5 In addition, there is never any guarantee that any of these pockets of sperm will be found when either of these 2 procedures is performed.

[学科分类] 基础医学