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The testicular-epididymal component includes sperm and comprises about 5% of the ejaculate volume. However, it could be the future for the treatment of multiple diseases, including infertility.

Conventional IVF vs ICSI (Intra Cytoplasmic Sperm Injection) for Patients Requiring Microsurgical Epididymal Sperm Aspiration (MESA). (PDF, 4 MB) Chapter from textbook, Frontiers in Endocrinology: Perspectives on Assisted Reproduction, 1994. Therefore, data estimating the prevalence of infertility cited by various sources differs significantly.[8] A couple that tries unsuccessfully to have a child after a certain period of time (often a short period, but definitions vary) is sometimes said to be subfertile, meaning less fertile than a typical couple. The following problems are possible: Low sperm count: The man ejaculates a low number of sperm. Sperm counts can fluctuate, so that several samples may be necessary. The farther from the scrotum, and the longer duration that the testicle resides outside the scrotum, the greater the likelihood of infertility. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

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There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. It does not include procedures in which only sperm are manipulated, such as intrauterine insemination, or procedures in which a woman takes drugs only to stimulate egg production, without the intention of having eggs retrieved. 8 Couples with unexplained infertility may want to consider another year of intercourse before moving to more costly and invasive therapies, such as assisted reproductive technology. Ultrasound can detect uterine abnormalities such as fibroids and polyps, distal fallopian tube occlusion, and ovarian abnormalities including ovarian cysts.

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Further investigations 18. Laparoscopy: - Invasive procedure. - to check for pelvic disease; such as endometriosis and to check tubal patency. - therapeutic as in laparoscpic myomectomy and ovarian drilling. Hysteroscopy: - to evaluate uterine cavity. - In case of repeated failed IVF cycles. - therapeutic as in intrauterine septum. Prostatitis can be subclinical or contribute to subfertility and infertility in dogs.

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The use of Epididymal and Testicular Spermatozoa for Intracytoplasmic Sperm Injection: The Genetic Implications for Male Infertility. (PDF, 8 MB) Human Reproduction, 1995. Normal Intrauterine Pregnancy After Reversal of Tubal Sterilization in the Wife and Vasectomy in the Husband.(PDF, 1 MB) Fertility and Sterility, 1978. The sperm moves up the cervix, towards the uterus, and into the fallopian tubes to reach and fertilize the egg. Hormonal Problems A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: · The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates   the hormonal pathway that causes testosterone synthesis and sperm production.  A disruption in   GnRH release leads to a lack of testosterone and a cessation in sperm production. · The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone   (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates   in the hormonal pathway responsible for testosterone and sperm production. · The testes� Leydig cells may not produce testosterone in response to LH stimulation. · A male may produce other hormones and chemical compounds which interfere with the   sex-hormone balance. Laurence-Moon-Biedl syndrome Patients with this syndrome have retinitis pigmentosa and polydactyly. Theoretically, with this therapy, we can get artificial gamets in vitro. Normal Pregnancies Resulting from Testicular Sperm Extraction and Intracytoplasmic Sperm Injection for Azoospermia Due to Maturation Arrest. (PDF, 6 MB) Fertility and Sterility, 1996. Paternal age > or = 40 years: an important risk factor for infertility. The incidence of congenital malformation in IVF babies ranges between 2% and 3% worldwide and is similar to that in babies conceived naturally [45]. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.[21] The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn.