Azoospermia is defined as lack of sperm cells in the ejaculate. Two types of azoospermia are known: obstructive in which normal spermatogenesis is present in the testes, and non-obstructive azoospermia which usually represent testicular failure. In almost two thirds of non-obstructive azoospermic patients, isolated regions of spermatogenesis exist. Recent advances in micro-manipulation and procedures for testicular sperm extraction (TESE) allow for in vitro fertilization via an intracytoplasmic sperm injection (ICSI) procedure, and thereby, providing the option of genetic offspring [1]. The testis is not homogeneous, thus, spermatogenesis may take place in certain sites, but not in others. Currently, there are no clinical, seminal or hormonal parameters for identification of regions with spermatogenesis, and as a result, multiple biopsies are arbitrarily performed at several sites of both testes until spermatozoa are found. However, it was suggested recently that areas of residual spermatogenesis in azoospermic men were expected to be found in blood perfused regions of the testicular tissue [2]. We developed a computerized, non-invasive method that predicts where spermatozoa are most likely to be found within the testis upon a three dimensional (3-D) distribution of testicular blood vessels reconstructed from power Doppler ultrasound (PDUS) images.
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