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Evidence-based medicine when the evidence is poor

Evidence-based medicine when the evidence is poor
There have been many advances in the management of infertile men over the last two decades. Genetic causes of impaired spermatogenesis are routinely screened for in men with severe oligospermia and often are identified as the cause of a man’s subfertility. Azoospermia due to impaired spermatogenesis was untreatable when I trained as a resident. Patients with nonobstructive azoospermia were told the only option to start a family was through donor insemination or adoption. We now can offer testicular sperm extraction and frequently find and use sperm for intracytoplasmic sperm injection.

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