Section II - Infertility Marc Goldstein Dramatic advances have been made in reproductive biology that were unthinkable just a few years ago. The widespread use and success of in vitro fertilization (IVF) with intracytoplasmic injection of a single sperm (ICSI) into a mature oocyte has expanded our ability to treat all but the most severe cases of testicular failure. These techniques, although initially feared by urologists as a replacement for male infertility treatment, have instead expanded the applications of male infertility surgery. Pregnancy rates with epididymal and testicular sperm aspiration in men with unreconstructable obstructions now exceed 50%. For nonobstructive azoospermia, testicular sperm can be retrieved in almost half of such men, even those with small testes and elevated follicle-stimulating hormone (FSH) levels. Testicular biopsy, previously performed only in men with normal testis volumes and normal FSH levels, is now indicated in all azoospermic men. Furthermore, testis biopsy is frequently both a diagnostic and therapeutic procedure. Any sperm retrieved at the time of diagnostic biopsy can either immediately be used for IVF with ICSI or cryopreserved for future use. Microsurgical varicocelectomy has resulted in return of sperm to the ejaculate in 50% of azoospermic men with testicular failure in previously hopeless cases. The discovery of Y chromosome microdeletions in men with nonobstructive azoospermia and cystic fibrosis gene mutations in men with congenital absence of the vas deferens has made genetic evaluation an essential part of the male infertility evaluation. Varicocele, long known to be associated with male infertility, has now clearly been shown to result in progressive, duration-dependent testicular injury. Surgical repair of varicocele previously was reserved for men already infertile. However, early repair of varicocele in adolescents using safer, more effective surgical techniques is helping urologists prevent future infertility. Many of the procedures described in this Atlas are among the most technically demanding in all of urology. This section provides a detailed, cutting-edge manual of diagnostic and therapeutic techniques in male infertility surgery.
Tom F. Lue, MD
Professor Department of Urology
University of California, San Francisco
Chief of Urology Mt. Zion Hospital San Francisco, California
Marc Goldstein, MD
Professor Department of Urology
Joan and Sanford I. Weill Medical College
Assistant Professorm Department of Urology
Graduate School of Medical Sciences of Cornell University
Director, Center for Male Reproductive Medicine and Microsurgery
Department of Urology New York Presbyterian Hospital
Staff Scientist Center for Biomedical Research, The Population Council New York, New York
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1 of 1 people found the following review helpful:
5.0 out of 5 stars
Physicians Guide to impotence and Infertility down to a T,
By A Customer
This review is from: Impotence and Infertility (Atlas of Clinical Urology, V.1 (Hardcover)
If you are looking for a book, that will give you in depth deatail, of problems such as Impotence/Infertility..then this is the book for you.. The pictures are great, and it is an easy read. Some parts are really in depth, and if you aren't a physician then you may have troubnle understanding some points, but except for that it is a great book, and I definetely recommend this to any one with an interest.
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