Laboratory handling of epididymal and testicular spermatozoa: What can be done to improve sperm injections outcome (original) (raw)
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Andrology, 2016
Spermatozoa can be retrieved in non-obstructive azoospermia (NOA) patients despite the absence of ejaculated spermatozoa in their semen because of the presence of isolated foci with active spermatogenesis. Conventional testicular sperm extraction (c-TESE) in patients with NOA has been partially replaced by micro-TESE. It is still under debate the problem regarding the higher costs related to micro-TESE when compared with c-TESE. In this study, we evaluated sperm retrieval rate (SRR) of c-TESE in naive NOA patients. Sixty-three NOA patients were referred to our centre for a c-TESE. For every subject, we collected demographic data, cause of infertility, time to first infertility diagnosis, serum levels of LH, FSH, total testosterone and prolactin. A statistical analysis was conducted to correlate all the clinical variables, the histology and the Johnsen score with the SRR. Sixty-three consecutive NOA patients with a mean age of 37.3 years were included. The positive SRR was 47.6%. No statistical differences were observed between positive vs. negative SRR regarding mean FSH (17.12 vs. 19.03 mUI/mL; p = 0.72), and LH (9.72 vs. 6.92 mUI/mL; p = 0.39) values. Interestingly, we found a statistically significant difference in terms of time to first infertility diagnosis (+SRR vs. ÀSRR; 44.5 vs. 57 months; p = 0.02) and regarding to age (+SSR vs. ÀSRR; 40.1 vs. 35.3; p = 0.04). There was a statistically significant decrease in SRRs with the decline in testicular histopathology from hypospermatogenesis to maturation arrest, and SCO. The mean Johnsen score was 5.9 with a mean percentage of Johnsen score ≥8 tubules equal to 19%. The overall pregnancy rate was 26.6%. In our prospective cohort of patients successful SRR with c-TESE was 47.6%. Lower costs and high reproducibility of this technique still support this procedure as an actual reliable option in NOA patients for sperm retrieval.
Sperm retrieval techniques for assisted reproduction
International braz j urol, 2011
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.
Nature Reviews Urology, 2013
Since the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures have been routinely employed to treat male infertility owing to azoospermia. With obstructive azoospermia, sperm is potentially harvestable from the vas deferens, epididymis, and testicle using percutaneous and open sperm retrieval procedures that are relatively straightforward and reliable. In nonobstructive azoospermia, sperm is generally found only in the testicles and can often be difficult to retrieve. Several approaches aimed at maximizing sperm yield in this condition have been developed, but only 50% of men with nonobstructive azoospermia will have clinically usable sperm. Multibiopsy testicular sperm extraction (TESE), microdissection TESE, and fine-needle-aspiration map-guided TESE are three common methods currently employed to locate and retrieve sperm in these difficult cases. Other factors that influence the use of surgically retrieved sperm for assisted reproduction include differences in sperm DNA integrity, the expertise of the surgeon and the andrology laboratory, and the described differences in the viability of sperm from different anatomical sources after freezing and thawing.
Testicular sperm retrieval for assisted reproductive techniques
Reviews in Gynaecological Practice, 2004
The possibility of achieving a pregnancy with just one spermatozoon has led to the evolution of a number of methods aiming to obtain sperm from testicular tissue. This achievement now offers men with azoospermia a reasonable chance of fathering their own children. The choice of the best testicular sperm retrieval technique has always been a challenge. There has been a trend to use percutaneous needle aspiration but controlled studies have demonstrated that open testicular biopsy is necessary to obtain the best results, particularly in non-obstructive azoospermia. Since azoospermic men are at risk of specific genetic defects, careful genetic testing and counselling prior to treatment should be considered to allow the couple to make an informed decision as to whether or not to use the husband sperm. The recovery of sperm may not always be successful particularly in non-obstructive azoospermic men, an event that encompasses important emotional and financial implications. Unfortunately, no clinical or laboratory test can clearly predict success with sperm retrieval procedures.
T he authors from Turkey smartly show the predictive factors for successful sperm retrieval rate (SRR) with microdissection testicular sperm extraction (micro-TESE), carried out on men with non-obstructive azoospermia (NOA). In men with NOA, retrieval of spermatozoa provides a chance for fatherhood, in spite of very scares sperm production. Men go through assessment for infertility are found to have azoospermia in their ejaculate in up to 10% of the cases. (1) Around 60% of these cases are due to NOA. (2) Men with NOA need some type of sperm retrieval (SR) technique in combination with intra-cytoplasmic sperm injection (ICSI) to have their own children. There are some methods for SR, including, percutaneous testicular biopsy, fine needle aspiration (FNA), open testicular biopsy (testicular sperm extraction (TESE), which includes multiple TESE), and micro-TESE. Micro-TESE is now one of the most popular SR techniques for men with NOA. Although the success of micro-TESE compared to other SR techniques has been widely documented, a complete judgment of predicting preoperatively whom the technique is going to be successful is not totally clear and remains controversial. In addition reported SRR can be biased either by including patients demonstrating nearly normal spermatogenesis, or by inclusion of patients without available testicular histology. Therefore, successful SRRs reported in the literature for NOA men differ from around 30% to level more than 80%. In well-designed studies with well-defined men with NOA, the reported successful SRRs after a first TESE attempt is about 50%. Nonetheless, due to invasive nature of TESE, men with NOA want to have a well prediction of likelihoods of successful SRR than tossing a coin. Since testicular volume and serum follicle stimulation hormone (FSH) levels are routinely evaluated in men with azoospermia, these parameters are regularly used, alone or in combination, to predict successful SR. Unfortunately, their predictive value remains restricted and is subject to the demographic and clinical characteristics of the studied patients with NOA. Idem ditto for the predictive parameters for successful SR has been published by Boitrelle and colleagues. The positive likelihood ratios for the stand-alone parameters are less than 2 and hereafter not of a great diagnostic power in predicting testicular SRR. With a positive likelihood ratio of 3, a predictive score combining serum FSH concentration, testicular volume, and serum inhibin-B level, seems more favorable in their setting. Nevertheless again, is this a strong predictive model appropriate to every men with NOA? All seminiferous tubules (ST) must be inspected to recognize small foci of normal spermatogenesis. The STs are extremely coiled within very fine septae. The dissection should be performed between tubules to permit access to deeper portions of the STs. The space between the tubules and the tunica is very vascular, thus hemorrhage that would be very difficult to control can happen if dissection is made in this plane. To avoid separation of STs from their blood supply and thus devascularization of the STs, unnecessary force during the dissection should be avoided. Postoperative hemorrhage and hematoma formation after micro-TESE can result in scar formation within the testis. Cautious dissection and careful hemostasis, will minimize these complications. Microdissection continues until sperm are found or all areas of both testes are examined. Usually, small samples of 2-10 mg are taken. If sperm are not found in one testis, the process should be repeated in the contralateral testis. When sufficient sperm are obtained, hemostasis is accomplished using bipolar cautery. Improvement of spermatogenesis before proceeding to SR should be tried in cases where the female age permits. Hormonal therapy can increase endogenous testosterone (T) production and normalize the testosterone/estrogen ratio in men with documented hypogonadism. Hormonal therapy includes administration of aromatase inhibitors, clomiphene citrate, and human chorionic gonadotropin (HCG). In patients with Klinefelter's Syndrome and low serum T level, when T increases to greater than 250 ng/dL with medical therapy, SRR with micro-TESE will be higher. (4) The rationale behind of such treatment based on the fact that most men with NOA have small testes with reduced T production and hypogonadism. Sufficient intratesticular androgen levels are vital to maintain normal spermatogenesis. In some cases with NOA gonadotropins administration are worthwhile, these include
Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia
International Braz J Urol, 2003
OBJECTIVES: Assessing the efficiency of repeated percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia, and also the possibility of cryopreservation of remaining material for future use in intracytoplasmic sperm injection (ICSI). METHOD: Retrospective study, in which 79 procedures of PESA were assessed in 58 patients (mean age = 45 years), whose partners had mean age of 34 years. Vasectomy was the most frequent cause of obstructive azoospermia (n = 46). RESULTS: Motile spermatozoa were obtained in 65 procedures (82%). PESA was twice repeated for 15 patients, 3 times for 5 patients, and 4 times for 1 patient. Spermatozoa were found in 13 (87%) patients in the second attempt, in 4 (80%) patients in the third attempt, and in the only patient that had accomplished 4 procedures. In 30 procedures (37%), we have obtained enough material for cryopreservation. In 12 among the 13 samples thawed (n = 13 patients), motile spermatozoa were found, and ICSI was accomplished. Four patients that did not use their samples requested the elimination of the material. Total rate of pregnancy per transference was 21/55 (38%). In 14 PESA procedures, it was not possible to find spermatozoa; in these cases, the patients opted for accomplishing the procedure of testicular sperm aspiration (TESA). CONCLUSION: PESA is an efficient and simple method of retrieving spermatozoa, allowing repeated procedures. Additionally, spermatozoa collected through PESA can be cryopreserved.
Testicular Sperm Extraction Techniques in Subfertile Males
Nepalese Medical Journal, 2020
Introduction: Assisted conception is an option for subfertile couples. Surgical sperm retrieval by testicular sperm aspiration and testicular sperm extraction are widely used safe techniques to yield sperm for intracytoplasmic sperm injection. Experience with these techniques is presented. Materials and Methods: A retrospective study of testicular sperm retrieval for assisted reproduction is presented. Testicular sperm aspiration is attempted on all azoospermic males with normal sexual characteristics. Testicular sperm extraction is attempted on consenting patients where aspiration has failed. Donor sperm injection is done to oocyte of a spouse on the failure of both techniques. Results: Sixty-six percent of males had adequate numbers and characters of viable spermatozoa on testicular sperm aspiration. Further 53.3% of patients where aspiration failed yielded spermatozoa on testicular sperm extraction. Thus overall 77.1 % of patients with azoospermia benefi tted from testicular sper...