Nonobstructive azoospermia: a revolutionary surgical approach and results.

The treatment of nonobstructive azoospermia was developed and has evolved rapidly over the past decade. Extraction of spermatozoa from the limited sites of sperm production in the testes of men with nonobstructive azoospermia has been a primary challenge to the successful treatment of these patients. Using a microsurgical approach referred to as microdissection testicular sperm extraction, sperm retrieval is effective in 60% of men with nonobstructive azoospermia, including 70% of difficult cases, such as men with Klinefelter syndrome. Pregnancy is possible in 45% of couples once sperm are obtained. The microdissection approach seems to be safer than other sperm retrieval approaches and with a higher yield of sperm from men with nonobstructive azoospermia. Its specific application for subsets of men with nonobstructive azoospermia is described.