Assisted reproduction for testicular failure: management of germ cell maturation arrest.

The availability of current, state of the art technology has enabled an efficient treatment in cases of infertility caused by testicular failure in which mature spermatozoa or late elongated spermatids can be recovered from the ejaculate or the testis. In those patients in whom only germ cells at earlier stages of spermatogenesis are present, results of the currently available treatments are still inconsistent and largely unpredictable, although some encouraging developments have been achieved over the past year. These new results suggest that developmental failure after fertilization with immature germ cells is mainly due to germ cell apoptosis and shows that an efficient selection of healthy germ cells can be achieved by in-vitro culture. In some cases, this method also allows premeiotic germ cells to achieve in-vitro transmeiotic maturation and thus enables men with in-vivo premeiotic maturation arrest to father a child.