While some of the underlying causes of nonobstructive azoospermia may be reversible to a degree, advanced assisted reproductive techniques are needed for the majority of patients with this condition. With the advent of assisted reproductive technology, particularly ICSI combined with testicular sperm extraction (TESE), many of these men are now able to father their own biological children. buy levaquin online
For men with nonobstructive oligospermia or azoospermia, rare sperm can sometimes be found in the ejaculate for ICSI. More often, however, retrieval of sperm from the testis is required. Various techniques of sperm retrieval for these patients have been documented . Testicular sperm aspiration (TESA), in which a gauge 21 to 25 needle is inserted into the testis parenchyma percutaneously, has been used to aspirate sperm. The success rate of sperm retrieval in nonobstructive azoospermia has been poor, with a significant risk of vascular injury and hematoma formation postoperatively. TESE in the form of an open biopsy has been more successful for these patients. In an attempt to limit the amount of testicular tissue removed and to minimize the risk of vascular injury, a microsurgical technique has been employed in TESE. Using the microdissection technique, sperm have been identified in 50% of men explored. In those men in whom sperm are found, a pregnancy rate of 50% has been achieved using in vitro fertilization and/or ICSI. The spontaneous abortion rate is 19%. The high rate of spontaneous abortion is probably due to the increased incidence of chromosomal abnormalities and DNA damage in the sperm of men with nonobstructive azoospermia. Even in severe cases of congenital or acquired testicular failure, as in Sertoli-cell-only syndrome, postchemotherapy azoospermia and nonmosaic (47 XXY) Klinefelter’s syndrome, sperm have been found and pregnancy and live births have been achieved.