Sperm retrieval for obstructive azoospermia

doi:10.1016/j.fertnstert.2006.07.1490

Cited by 8 publications

(4 citation statements)

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“…[1112131426] Nonetheless, the adoption of strict criteria to diagnose NOA is crucial for the indication of micro-TESE since it is an invasive procedure with potential complications. [2327] Hence, we confirmed the diagnosis of NOA by histologic evaluation in all individuals. In addition, we confirmed the presence of azoospermia by analyzing centrifuged semen specimens obtained immediately before the procedures since rare sperm may occasionally spill over into the ejaculates of such patients.…”

Section: Discussionsupporting

confidence: 66%

“…[39] Despite being unable to obtain sperm in our patient with KS, SRR of micro-TESE in such men have been reported to range from 55% to 75%. [1727]…”

Section: Discussionmentioning

confidence: 99%

“…Microsurgery also allows preservation of intratesticular blood supply; excellent hemostasis is achieved, thus reducing the chance of complications due to hematoma formation and testicular devascularization as it may occur in cases of conventional TESE. [21227] In addition, removal of excessive amount of testicular parenchyma may jeopardize androgen production and limit the chances of repeated SR, which are particularly important for men with NOA who usually have small and highly dysfunctional testes. [8] Despite declining after micro-TESE, androgen production recovers to preoperative levels in the vast majority of patients within 12−18 months.…”

Section: Discussionmentioning

confidence: 99%

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Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

Ashraf¹,

Singh²,

Raj³

et al. 2013

J Hum Reprod Sci

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CONTEXT:Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results.AIMS:We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR.SETTINGS AND DESIGN:Case series of men with NOA treated in a tertiary healthcare center.MATERIALS AND METHODS:An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes.STATISTICAL ANALYSIS:Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR.RESULTS:The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%.CONCLUSIONS:We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.

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Section: Discussionsupporting

confidence: 66%

“…[39] Despite being unable to obtain sperm in our patient with KS, SRR of micro-TESE in such men have been reported to range from 55% to 75%. [1727]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

Ashraf¹,

Singh²,

Raj³

et al. 2013

J Hum Reprod Sci

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“…SRRs by micro-TESE are significantly higher in hypospermatogenesis (93%) than with MA (64%) and SCOS (20%). [34] Nonetheless, successful retrievals are reported even in the more adverse histopathology pattern of SCOS, as shown in the aforementioned study. This observation indicates that sperm production is distributed in a heterogeneous pattern within the testis, and histologic assessment of a single testicular fragment is limited in its ability to determine the presence of rare foci of sperm production in NOA.…”

Section: Discussionmentioning

confidence: 77%

Microdissection testicular sperm extraction: Overall results and impact of preoperative testosterone level on sperm retrieval rate in patients with nonobstructive azoospermia

et al. 2019

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Objective: The main objective is to review the overall result and impact of preoperative testosterone level on sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Materials and Methods: We retrospectively reviewed the files of patients who underwent micro-TESE for NOA from August 2013 to December 2014. All patients were evaluated with history, physical examination, and hormonal assessment. Patients who had previous micro-TESE, obstructive azoospermia, or who took hormone therapy were excluded from the study. Patients were classified into two groups. Group A included patients who had low testosterone (<10 nmol/L), and Group B included patients with normal testosterone (>10 nmol/L). The primary endpoint was to review the overall results of the procedure and the impact of preoperative testosterone level on sperm retrieval. Results: A total of 264 patients with NOA underwent micro-TESE. Group A included 133 patients with low testosterone (<10 nmol/l) with a median age of 36 ± 6.59 years, and Group B included 131 patients with normal testosterone (>10 nmol/L) with a median age of 33 ± 7.88 years ( P = 0.1350). There was no significant difference in follicle-stimulating hormone ( P = 0.2467), luteinizing hormone ( P = 0.1078), prolactin ( P = 0.5619), and testicular volume ( P = 0.4052), whereas a significant difference was found in testosterone level ( P = 0.0001) in both groups. Overall, sperm were successfully retrieved in 48.8% of men. SRR in Group B was significantly higher (57.25%) than that in Group A (40.60%) ( P = 0.0068). SRR in patients with Sertoli-cell-only pathology was 30.35%, hypospermatogenesis was 89.74%, and maturation arrest was 32.43%. Conclusion: Micro-TESE is a successful and safe procedure in NOA patients with a poor prognosis. Preoperative testosterone level has a significant impact in the SRR by micro-TESE.

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Validation-verification of a highly effective, practical human testicular tissue in vitro culture-cryopreservation procedure aimed to optimize pre-freeze and post-thaw motility

Schiewe

Rothman

Spitz

et al. 2016

J Assist Reprod Genet

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Purpose The aim of our paper was to validate a testicular biopsy procedure that simplifies handling, processing, and cryopreservation, while at the same time optimizes sperm motility before freezing and after thawing.MethodsTwo prospective studies were conducted to verify, optimize, and understand the virtues of pre-freeze testicular tissue IVC at different temperatures (21, 30, or 37 °C). Testicular tissue was obtained from clinical specimens designated for whole tissue cryopreservation (i.e., intact mass of tubules) and/or for fresh use in IVF-ICSI cycles. Whole testicular biopsy pieces (1–3 mm3) were diluted in glycerol containing freeze solutions, slow cooled to 4 °C and then rapidly frozen in LN2 vapor. Fresh and post-thaw testicular biopsy tissue were evaluated for changes in the quantity (%) and pattern of motility (I–IV: twitching to rapid progression, respectively) over a 1 week duration. The clinical effectiveness of IVC-cryopreserved whole testicular biopsy tissue was also validated analyzing fresh embryo transfers.ResultsMore reliable recovery of motile testicular sperm was achieved using whole tissue freeze preservation combined with IVC (24–96 h) post-acquisition at an incubation temperature of 30 °C compared to ambient temperature (21 °C) or 37 °C. Up to 85 % of the pre-freeze motility was conserved post-thaw (+3 h) for easy ICSI selection. Sperm longevity was optimized to fresh tissue levels by implementing testicular biopsy sucrose dilution post-thaw. Favorable clinical outcomes were proven using frozen-thawed testicular biopsy sperm for ICSI.ConclusionsBy employing minimal tissue manipulation, integrating pre-freeze IVC processing at 30 °C and the freezing of whole testicular biopsy tissue, we have reduced the labor and improved the efficacy of processing testicular tissue for freeze-preservation and subsequent ICSI use.

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Sperm retrieval for obstructive azoospermia

Cited by 8 publications

References 25 publications

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

Microdissection testicular sperm extraction: Overall results and impact of preoperative testosterone level on sperm retrieval rate in patients with nonobstructive azoospermia

Validation-verification of a highly effective, practical human testicular tissue in vitro culture-cryopreservation procedure aimed to optimize pre-freeze and post-thaw motility

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