Round spermatid injection.

This finding has caused great concern with round spermatid enthusiasts. A major complaint is that “one should not restrict the label of round spermatid only to those cells in which an acrosomal vesicle is visible” (p. 2977) (4). However, our observation is based not only on phase-contrast evaluation of TESE microdroplets but also on detailed stained histology of many hundreds of testis specimens and on the previous literature on the histology and pathology of maturation arrest (5–10). The atlas of phase-contrast wet preparation cells published by Johnson et al. (5, 6) attests to the difficulty of distinguishing round spermatids from Leydig cells, Sertoli cell nuclei, and even spermatogonia without staining and whole tissue fixation. The only reason we concentrate on the albeit transient acrosomal vesicle with phase contrast is to provide an easy identification marker for wet microdroplet ICSI preparations. The absence of round spermatids in wet TESE preparations determined by phasecontrast visualization of the acrosomal vesicle in the intracytoplasmic sperm injection (ICSI) setting merely confirms what was already demonstrated in fixed, stained tissue specimens over many years (Figs. 1 and 2).