Surgical treatment for male infertility

Abstract

Infertility complaint is common in the urologic office. The role of the urologist in this context cannot be underestimated, since he/she is trained to diagnose, to counsel, to provide medical or surgical treatment whenever possible, or to correctly refer the male patient for assisted conception. The urologist can also be part of the multi-professional reproductive team in the assisted reproduction unit, being responsible for the above-cited tasks as well as for the sperm surgical retrieval from the epididymis or testicle. Two major breakthroughs occurred in the area of male infertility with regard to treatment. The first was the development of microsurgery which increased success rates for reconstruction of the reproductive tract. The second was the development of intracytoplasmic sperm injection (ICSI) and the demonstration that spermatozoa retrieved from either the epididymis or the testis were capable of fertilization and pregnancy. Thereafter, several sperm retrieval methods have been developed to collect epididymal and testicular sperm for ICSI in azoospermic men. Microsurgery was incorporated to this armamentarium, either for collection of sperm from the epididymis in men with obstructive azoospermia or from the testicle in those with nonobstructive azoospermia. This chapter describes the most common surgical treatments for male infertility. It includes not only the reconstructive interventions for the male reproductive system but also the sperm retrieval techniques to be used in cases of obstructive (OA) and nonobstructive azoospermia (NOA). A critical commentary, based on the authors' experience in the surgical management of infertile males, and a review of important publications from the last 5 years are included. Finally, a list of key issues is provided to summarize the current knowledge in this area.