The diagnosis and treatment of the azoospermic patient in the age of intracytoplasmic sperm injection

Optimal management of the patient with azoospermia requires accurate diagnosis and determination of the etiology. Men with obstructive azoospermia benefit most from reconstruction. For men in whom reconstruction is not feasible, sperm retrieval techniques are highly effective when used in conjunction with intracytoplasmic sperm injection (ICSI). For most patients with nonobstructive azoospermia who remain azoospermic following the treatment of correctable conditions such as varicocele and hormone abnormalities, the application of microdissection testicular sperm extraction will yield sperm for use in ICSI. The advent of ICSI has dramatically changed the treatment of azoospermia, allowing men with severe male factor infertility, previously considered sterile, the possibility to produce biologic offspring.