Assisted fertilization with epididymal spermatozoa.

In vitro fertilization is used for several years as a technique for resolving infertility problems due to moderate or severe oligospermia. More recently, techniques of micro-insemination of oocytes have also become available for cases of extremely severe oligospermia which cannot be resolved by classical I.V.F. Nevertheless, although these particular techniques have already led to results which have gone far beyond initial hopes, they are not able to resolve all cases of male sterility. There are indeed many situations of excretory azoospermia associated with normal spermatogenesis; the spermatozoa remain trapped in a more or less extensive part of the epididymis because its passage is blocked, either because of post-infectious sclerosis, or of agenesis of a variably extensive area of the Wolffian duct. Post-inflammatory occlusions can be treated by micro-surgery, whereas in cases of agenesis, attempts to collect spermatozoa by means of an artificial spermatocele have led to far too many failures, and this technique has now been abandoned, in spite of some successful pregnancies. The extraordinary development of in vitro fertilization techniques has led to the logical idea that it might be possible to collect epididymal spermatozoa for oocyte fertilization.