Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia

Esteves, Sandro C.; Verza, S.; Prudencio, C.; Seol, Bill

doi:10.1016/j.fertnstert.2010.07.532

Cited by 14 publications

(23 citation statements)

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“…Testicular sperm have been obtained in all etiology categories of cryptorchidism, orchitis, genetic, radio-/chemotherapy and idiopathic (5,6,10,17,18,21,23). Efficiency of sperm retrieval in NOA males varies according to the method of sperm collection.…”

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

“…TESA retrieval rates range from 10-30% (22,23,(39)(40)(41), except in the favorable cases of previous successful TESA or testicular histopathology showing hypospermatogenesis. In such cases, TESA SRR range from 70-100% (6,10). In a recent systematic review the mean reported SRR for TESE was 49.5% (23).…”

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

“…Retrieval rates ranging from 35% to 77% have been reported for micro-TESE (17)(18)(19)21,23,42,43). Current evidence suggests that micro-TESE performs better than conventional TESE or TESA in cases of maturation arrest and SCO, where tubules containing active focus of spermatogenesis can be identified (6,10,42). Moreover, tissue removal in micro-TESE is often 50 to 70-fold less than conventional TESE (17,43), and the small amount of tissue extracted facilitates sperm processing.…”

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

“…However, a biopsy may be considered to determine the likelihood of sperm retrieval in ICSI candidates with NOA. The presence of either spermatozoa on a wet prep or hypospermatogenesis on testicular histopathology is highly predictive of successful sperm retrieval in future retrieval attempts (8,10). Conversely, the absence of sperm in a biopsy specimen does not absolutely exclude the chances of finding sperm elsewhere within the testis due to the heterogenic distribution of spermatogenesis in NOA men (5,8,10).…”

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confidence: 99%

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Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

127

117

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Different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE have been developed to retrieve spermatozoa from either the epididymis or the testis according to the type of azoospermia, i.e., obstructive or non-obstructive. Laboratory techniques are used to remove contaminants, cellular debris, and red blood cells following collection of the epididymal fluid or testicular tissue. Surgically-retrieved spermatozoa may be used for intracytoplasmic sperm injection (ICSI) and/or cryopreservation. In this article, we review the surgical procedures for retrieving spermatozoa from both the epididymis and the testicle and provide technical details of the commonly used methods. A critical analysis of the advantages and limitations of the current surgical methods to retrieve sperm from males with obstructive and non-obstructive azoospermia is presented along with an overview of the laboratory techniques routinely used to process surgically-retrieved sperm. Lastly, we summarize the results from the current literature of sperm retrieval, as well as the clinical outcome of ICSI in the clinical scenario of obstructive and nonobstructive azoospermia.

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Section: Non-obstructive Azoospermiamentioning

confidence: 99%

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

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confidence: 99%

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Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

127

117

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“…It is plausible to believe that administration of antioxidants, varicocelectomy and modifications in both the life-style and environmental exposure may play a role to infertile men with high sperm DNA damage. According to our experience involving approximately 200 individuals with NOA, successful SR rates of 55.7% have been achieved and results were similar in etiology categories of cryptorchidism, orchitis, genetic, radio-/chemotherapy and idiopathic [66]. Testicular histopathology results were predictive of sperm collection using both testicular sperm aspiration (TESA) and micro-TESE.…”

Section: Expert Commentarymentioning

confidence: 87%

What is New in the Clinical Assessment and Treatment of the Infertile Male

Esteves¹

2011

TORSJ

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Male infertility is a fast-evolving area. Recently published evidence has challenged several established concepts and added to the knowledge in the field. Traditionally, the clinical assessment of the subfertile male includes a history and physical examination, hormonal evaluation and semen analyses. Regarding the latter, the World Health Organization has established new reference values that in general include lower limits than those of previous editions. Specialized sperm function assays, such as sperm DNA integrity and measurements of oxidative stress, are now clinically available and may be integrated to the conventional semen analysis to provide a more comprehensive evaluation of a man's fertility status. Also, molecular biology genetic testing involving the Y-chromosome can correctly identify oligozoospermic and azoospermic men misdiagnosed as having idiopathic infertility and be of prognostic value for sperm retrieval in non-obstructive azoospermia. In the field of treatment, emerging evidence suggests that antioxidant therapy along with life-style modifications improve the male reproductive health. Microsurgery has increased the success rates for both varicocele treatment and sperm retrieval for assisted conception. Microsurgical treatment of clinical varicoceles may optimize reproductive outcome of couples undergoing intracytoplasmic sperm injection or microsurgical testicular sperm extraction. Men with non-obstructive azoospermia, elevated follicle-stimulating hormone levels and small testes may no longer be considered sterile. Modern retrieval techniques are used to collect testicular sperm that can be used to produce a healthy biological offspring via assisted conception. This article reviews what is new in the clinical assessment and treatment of the infertile male, including the implications of this increased knowledge in the management of the infertile couple and assisted reproduction technology outcomes.

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