Occupational infertility in the male has been a recognized entity since the identification in 1978 of the testicular toxicity of the nematocide 1,2-dibromo-3-chloropropane (DBCP) in factory workers producing it and farm workers using it. DBCP remains the best documented chemical testicular toxin, its effect being confined purely to testicular germinal epithelium. There is increased recognition of employer responsibility for workplace health and safety accompanied by a growing threat of litigation from affected persons. This has led to fertility risks within occupations also being considered, along with the traditional areas of physical and auditory safety and protection from potential carcinogens.

In contrast to the classic action of steroid hormones through cytoplasmic/nuclear receptors, there is an accumulating body of data which strongly suggests that they have a direct effect on cells mediated through putative membrane receptors, a so-called non-genomic action. Although such non-genomic effects were discovered 50 years ago it is only in the last 15 years that the subject has become an area of intense research.

Doppler ultrasound is a noninvasive method of investigating patterns of blood flow and its changes in the human circulatory system. Its use in the assessment of vascular disease is well established. Its application in gynaecology was first documented over a decade ago.

With the introduction of bilateral ovarian wedge resection (BOWR) in 1935, Stein and Leventhal were the first to describe an effective treatment for the chronic anovulation and associated infertility resulting from what was later to become known as polycystic ovary syndrome (PCOS). Since that time, many less invasive methods of ovulation induction and enhancement have been developed. While the success of medical ovulation induction led to the almost complete replacement of BOWR by the late 1970's, the presence of a group of women who are not optimally treated by medical methods has maintained the interest in surgical approaches. Surgical and nonsurgical methods of treatment for anovulatory women have continued to be refined. This manuscript reviews this literature and attempts to provide a framework for the role that modern surgical methods of ovulation induction might play in the current scheme of treatment for anovulatory infertility in women with PCOS.

During the past decade, few fields in medicine have changed as dramatically as reproductive medicine and the treatment of male infertility. Whereas previously only men with obstructive azoospermia were candidates for treatment, either through surgical reconstruction or sperm aspiration, now even men with nonobstructive azoospermia are able to achieve pregnancies without having to resort to donor sperm. The extraordinary success of assisted reproduction after sperm retrieval for azoospermic men is the result of three important discoveries. First is the clinical observation that epididymal transit of sperm is not required for successful fertilization. Second is the recognition that significant heterogeneity in testicular biopsy specimens exists. Lastly is the advent of intracytoplasmic sperm injection (ICSI), which has enabled fertilization regardless of the degree of sperm impairment or retrieval source as long as sperm are viable. These three discoveries have enabled fertilizations and pregnancies for men previously referred for donor insemination or adoption, and have therefore broadened the indications for sperm retrieval. This review is intended to describe in detail the available techniques for the recovery of sperm, with emphasis on the latest technique, testicular microdissection for sperm retrieval in nonobstructive azoospermia.

Testicular germ cell tumours are a rare and bizarre diversion in the life cycle of the male germ line. These neoplasms are thought to originate during embryonic life from primordial germ cells (PGCs) which fail to undergo maturation into prospermatogonia. Maturation arrest and the development of aneuploidy in the PGC give rise to the precursor of germ cell malignancy, the testicular carcinoma in situ (CIS) cell. Thereafter, a complex series of genetic changes, coupled with the onset of puberty, can either convert the CIS cell into a malignant tumour made up of cells resembling primordial germ cells (a seminoma), or drive it down a pathway akin to parthenogenesis, so that it acquires a special property shared with cells of the early embryo – pluripotentiality, or the ability to differentiate into a wide range of somatic cells. The latter form of germ cell tumour, a teratocarcinoma, will contain primitive undifferentiated stem cells and multiple somatic tissues representing derivatives of all three germ layers plus the extraembryonic membranes which support development. Pluripotentiality is a property common to the oocyte, the cells of the early embryo up to the stage just after implantation, primordial germ cells, and the stem cells of germ cell tumours (Figure 1).

Approximately 30–40% of couples seeking fertility treatments have male factor infertility. Their dysfunctions include azoospermia, oligozoospermia, asthenozoospermia and teratozoospermia. Those with azoospermia represent about 25% of the total, and of these about 30% have an obstructive process while the remaining have either primary or secondary testicular failure. In the obstructive azoospermia group, 25% of males have congenital bilateral absence of the vas deferens (CBAVD).