The treatment of male infertility has made incredible advances in the last few years. Men previously thought to be hopelessly infertile can now become fathers with the help of micromanipulation.

Percutaneous epididymal sperm aspiration (PESA) is particularly useful in men with obstruction of the vas deferens (the tube through which sperm passes from the testicle to the urethra). Pregnancy rates using epididymal sperm and conventional IVF techniques have resulted in relatively low success rates per attempt due to low fertilization rates. However, when ICSI is utilized, the pregnancy rates are equal to those in IVF in the absence of a male factor problem.

Testicular sperm exaction (TESE) has recently been used with ICSI to achieve good pregnancy rates when PESA is not feasible.

As with any new technology, there are concerns. Some men with severe male factor infertility have been shown to have chromosomal aberrations that are responsible for their infertility. These defects can be inherited by male offspring who may suffer from the same fertility problems as the father. Congenital absence of the vas deferens has been found to be associated with mutations of the cystic fibrosis (CF) gene. Men with congenital absence of the vas deferens should be screened for CF gene mutations and if mutations are found it is important that the female partner be evaluated for her CF status to assess the risk of transmission of the disease to children born from the reproductive technologies. The long-term consequences of any of the new assisted reproductive technologies are unknown.