Advances in Fertility Options of Azoospermic Men

Abstract

Infertility is defined as the failure of a couple to become pregnant after one year of regular, unprotected, sexual intercourse. Misconceptions about infertility are very common. Infertility affects roughly 15% of all couples during their reproductive lives. Infertility is not just a female problem as there is a male infertility component in approximately 50% of couples. A couple experiencing infertility should not underestimate the significance of the problems that can exist in the male. Male infertility may be the sole contributing reason for the couple's failure to conceive and should be best identified by a male infertility specialist. According to the 2009 national summary report of the American Society for Assisted Reproductive Technology, nearly 35% of infertility is attributed to the male factor. In the late last century, treatment for severe male factor infertility was limited to inseminations or in vitro fertilization using donor sperm. However, most infertile couples, and particularly men, are reluctant to use donor sperm because of bias maintained across cultural and ethnic boundaries. Today, exciting advances in male infertility have introduced innovative therapeutic options, in particular, intracytoplasmic sperm injection (ICSI), which offers men, including those with no sperm (azoospermia) in their ejaculate due to genetic conditions, a greatly improved chance to conceive their own biological offspring (Palermo, et al.. 1992). Currently, despite severe male factor infertility, pregnancy may still be achieved. This is mainly attributed to the success of the ICSI technique and advanced surgical testicular sperm retrieval techniques. In recent years, the ICSI technique has evolved into intracytoplasmic morphologically selected sperm injection (IMSI) and a method for selection of hyaluronan bound sperm for use in ICSI (PICSI) (Parmegiani et al., 2010a,b; Said & Land 2011; Berger et al., 2011), resulting in significantly increased fertilization and pregnancy rates over the world IVF clinics. Because the advanced ICSI technique in human IVF is covered in depth by other chapters of this book, the main emphasis here will be on the application of testicular biopsy sperm, round or elongated spermatids from azoospermic men to human IVF as well as explore new technologies to produce artificial sperm from stem cells and somatic cells.