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This chapter covers topics including: (1) timing of sperm retrieval, particularly whether or not it should be performed in conjunction with oocyte retrieval from the female partner; (2) processing of surgically retrieved sperm for intracytoplasmic sperm injection (ICSI) –which are the most appropriate types of sperm preparation techniques in cases of epidydimal- or testicular-retrieved spermatozoa, and low or high numbers of retrieved spermatozoa; (3) selection of surgically retrieved sperm for ICSI, including methods for the selection of immotile spermatozoa, if needed, such as mechanical touch technique, hypoosmotic swelling test, chemical motility enhancers (e.g., pentoxifylline and theophylline), laser-assisted immotile sperm selection, and birefringence–polarization microscopy; (4) artificial oocyte activation, which may be useful in those selected patients who might have low fertilization potential, as well as the potential benefits of mechanical activation, electrical stimulation, and chemical activation on ICSI outcomes.
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