For patients with obstruction not amenable to surgical reconstruction or other treatments, those who elect to forego reconstruction, or for couples in whom a significant female factor (such as advanced age) requires the use of ICSI, sperm retrieval for assisted reproduction is an excellent option for the management of obstructive azoospermia. In virtually all patients with obstruction azoospermia, sperm can be obtained surgically. Using ICSI for obstructive azoospermia, pregnancy rates exceeding 60% can be obtained with motile sperm from either fresh or cryopre-served samples. buy flovent inhaler
Several techniques have been employed for sperm retrieval for obstructive azoospermia. Microsurgical epi-didymal sperm aspiration (MESA), in which sperm is collected from a microsurgically isolated epididymal tubule, results in retrieval of greater than 100×106 sperm, with motility sufficient for cryopreservation of multiple aliquots . If the patient is opposed to an open procedure, if a microsurgeon is not available to perform MESA, or if the couple is considering only one in vitro fertilization cycle, a percutaneous procedure may be employed. Percutaneous procedures include TESA, percutaneous epididymal aspiration of sperm and percutaneous testicular biopsy. It should, however, be emphasized that percutaneous procedures are associated with a greater risk of hematoma formation compared with open procedures.