from Section 3 - Gametes
Published online by Cambridge University Press: 07 August 2023
Infertility due to azoospermia may be overcome by surgically retrieving sperm from the epididymis or testicle followed by in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) and embryo transfer. The nature of the azoospermia (obstructive (OA) versus non-obstructive azoospermia (NOA)), the surgical approach (percutaneous versus open) and the timing of the sperm retrieval relative to oocyte retrieval for IVF/ICSI (fresh versus frozen sperm) contribute to the success of sperm retrieval and the number of viable sperm that will be available for the IVF/ICSI procedure. The goal of the surgical team should be to maximize the recovery of mature, viable sperm for ICSI while minimizing patient risk and cost. The laboratory processing the samples must minimize post-recovery cell damage, preserve sample sterility and strive to optimize the efficiency of the surgery when possible by cryopreserving excess sperm for future IVF/ICSI procedures. Lastly, these teams must work together to optimize the ease of surgery coordination with the IVF procedure. The relevant procedures for sperm preparation from epidymal aspirates or testicular biopsies will be described in this chapter.
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