Introduction

The introduction of intracytoplasmic sperm injection (ICSI) into routine clinical practice (Van Steirteghem et al., 1996) has had a dramatic effect on the management of severe male factor infertility. This is because only a few spermatozoa are needed to ensure the fertilization of retrieved oocytes, using this technique. If, for example, 10 mature oocytes are retrieved from a woman's ovaries following superovulation, it means that only 10 live spermatozoa will be required; one spermatozoon will be injected into each oocyte. This is unlike conventional in vitro fertilization (IVF) in which several thousand spermatozoa are added to the culture dish to ensure that one spermatozoon is able to fertilize each oocyte. Pregnancy rates following ICSI are comparable with rates obtained following conventional IVF in couples who do not have male factor problems (Aboulghar et al., 1996). This powerful effect of ICSI has consequently led to reconsideration of the management of certain male factor problems which were previously regarded as being incompatible with genetic parentage; the patients had invariably required the use of donor spermatozoa for insemination of their partners or the couple had adopted children or led a childfree existence. A number of operative techniques have now been developed for the recovery of spermatozoa from the testes and other parts of the male genital tract (Table 10.1).