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used for ICSI. Most authors recommend taking several testic- ular samples. A good correlation is seen between diagnostic biopsy histology and the likelihood of finding mature sperm cells during testicular sperm retrieval and ICSI. No clear rela- tionship has been found between successful sperm harvesting and FSH, inhibin B or testicular volume. In case of AZFa and AZFb microdeletions, no spermatozoa can be retrieved. Testicular sperm extraction is the technique of choice and shows excellent repeatability. Microsurgical testicular sperm extraction may increase retrieval rates.

Transurethral incision of ejaculatory ducts or midline prostatic cyst Distal obstructions of the genital tract are commonly caused by infections of the prostatic urethra and the accessory glands, or by a cyst in the midline of the prostate. Treatment of the obstruction by transurethral incision of the cyst or the ejaculatory ducts may lead to an increase in semen quality and, occasionally, spontaneous pregnancy. Long-term results, however, are disappointing.

Sexual Dysfunction For treatment of sexual dysfunction, see EAU Guidelines on Male Sexual Dysfunction.

Disorders of ejaculation Retrograde ejaculation and anejaculation can occur:

  • in neurological diseases, such as multiple sclerosis, diabe- tes mellitus (neuropathy), and spinal cord injuries;

  • following prostate surgery, bladder neck surgery, sym- pathectomy, and retroperitoneal surgery, such as lymph

168 Male Infertility

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