Andrology: Percutaneous epididymal sperm aspiration for obstructive azoospermia

Abstract

We report the use of percutaneous epididymal sperm aspiration as a simpler and more acceptable alternative to microscopic epididymal sperm aspiration for patients with obstructive azoospermia in whom bypass surgery is not feasible or has not been successful. Some contamination of the aspirate with blood is inevitable, but with careful sperm preparation techniques this can be reduced substantially in the final aliquot used for assisted conception. Spermatozoa with active forward progression may be used for gamete intra-Fallopian transfer treatment, but when this capacity is absent intracytoplasmic sperm injection is recommended. Three pregnancies were obtained in seven couples and a set of twins has been delivered.

Vasectomy reversal versus IVF with sperm retrieval: which is better?

“…The procedure that was first described by Craft et al [23] and Shrivastav et al [34], called for percutaneous aspiration of sperm from the epididymis under local anesthesia by skin infiltration and cord block. There has been concern regarding unreliable sperm acquisition/DNA damage compared with testicular aspiration [35].…”

Therapeutic testis biopsy for sperm retrieval

“…The mini-microepididymal sperm aspiration procedure described by Nudell et al [40] was performed with 62% of patients receiving minimal intravenous sedation, with successful retrieval of spermatozoa in 96% of men. General anesthesia has been used for percutaneous epididymal sperm aspiration (PESA) in several series [43][44][45]. This procedure usually involves multiple bilateral punctures, and may not be as reliable as the standard MESA procedure, as sperm retrieval rates were reported to range from 67% to 90% [43,45].…”

Recovery and Cryopreservation of Spanish Ibex Epididymal Spermatozoa

“…Several methods of epididymal sperm collection have been used. In humans, percutaneous epididymal sperm aspiration is a good alternative for certain patients with obstructive azoospermia [Shrivastav et al 1994]. In animals, a number of methods for recovering epididymal spermatozoa after death have been successful, such as retrograde flushing with Dulbeccós phosphate-buffered saline in mouflons [Garde et al 1995], puncturing the tubules of the caudae epididymides in African wild ruminants [Kilian et al 2000], and lacing the caudae epididymides with different media in mice [Songsasen et al 1998;An et al 1999] and African antelope species [Loskutoff et al 1996].…”