Processing and selection of surgically-retrieved sperm for ICSI: a review

Abstract

Although the technique of intracytoplasmic sperm injection (ICSI) has been a revolution in the alleviation of male infertility, the use of testicular sperm for ICSI was a formerly unseen breakthrough in the treatment of the azoospermic man with primary testicular failure. At the clinical level, different procedures of testicular sperm retrieval (conventional TESE, micro-TESE, FNA/TESA, MESA, PESA) are being performed, the choice is mainly based on the cause of azoospermia (obstructive versus non-obstructive) and the surgeon’s skills. At the level of the IVF laboratory, mechanical procedures to harvest the sperm from the tissue may be combined with enzymatic treatment in order to increase the sperm recovery rates. A number of techniques have been developed for viable sperm selection in males with only immotile testicular sperm available. However, large, well-designed studies on the benefit and safety of one over the other technique are lacking. Despite all the available methods and combinations of laboratory procedures which have a common goal to maximize sperm recovery from testicular samples, a large proportion of NOA patients fail to father a genetically own child. Advanced technology application may improve recovery rates by detection of the testicular foci with active spermatogenesis and/or identification of the rare individual sperm in the testicular suspensions. On the other hand, in vitro spermatogenesis or sperm production from embryonic stem cells or induced pluripotent stem cells might be future options. The present review summarizes the available strategies which aim to maximize sperm recovery from surgically retrieved samples.

ICSI using fresh and frozen PESA-TESA spermatozoa to examine assisted reproductive outcome retrospectively

“…However, a non-significant inclination favoring maximum CP rate, LBR, and lowest miscarriage rates were observed in fresh PESA as compared with the other 3 parameters. However, miscarriage rates between the fresh and frozen TESA were almost similar, with a percentage variation of only 0.5% and a difference in the increase in LBR in fresh TESA [37]. Therefore, further study with a large population size must be conducted to achieve statistically significant results.Progressively complex systems that are useful for making more-precise decisions on central spermatogenesis during medical procedures will enhance this viewpoint.…”

Development of ICSI

“…A more drastic limitation occurs in cases of spermatogenic arrest as there is no source of gametes available for use leaving in vitro spermatogenesis as the only treatment option for these couples to have their own genetic child. These procedures will also require ICSI as a method of choice for use to inject in vitro-derived sperm cells (Verheyen et al 2017). Even more dire are the cases with Sertoli-cell-only syndrome (SCOS) and germ cell aplasia, which would only benefit from Figure 4 ICSI outcome according to the kinetic status of injected ejaculate spermatozoa.…”

Novel method of histopathological analysis after testicular sperm extraction in patients with nonobstructive and obstructive azoospermia

“…Depending on the size or number of spermatogenic foci, this may neither be representative of the tissue extracted nor of the whole testis. As the sample for histology is usually obtained simultaneously with the biopsy for sperm retrieval, its usefulness in terms of predicting SSR is limited [ 25 ]. Moreover, performing more than a single testicular biopsy for histological purposes cannot be recommended.…”