Sperm retrieval techniques
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The document discusses sperm retrieval techniques for men with azoospermia, emphasizing the distinctions between obstructive and non-obstructive cases. It highlights the effectiveness of methods like microdissection testicular sperm extraction (micro-TESE) and testicular sperm aspiration (TESA), as well as the predictive factors affecting sperm retrieval success. Overall, it identifies that sperm retrieval rates and reproductive potential vary significantly based on the type of azoospermia and testicular histology.
Sperm retrieval techniques
- 1. Sperm Retrieval Techniques“Understanding Infertility” – New Delhi, India – August 2011SandroEsteves, MD, PhDDirector, ANDROFERTCenter for Male Reproduction and InfertilityCampinas, BRAZILEsteves, 1
- 3. AzoospermiaIt is not a synonymous of sterility Obstructive AzoospermiaSperm retrieval for ARTEpididymis
- 4. Testis
- 6. PERCUTANEOUS RETRIEVAL Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and intracytoplasmic sperm injection (ICSI) in obstructive azoospermic (OA) men according to the cause of obstruction. Fertil Steril. 2010;94 (Suppl):S233.
- 7. Non-obstructive AzoospermiaUntreatable conditionSperm Retrieval for ARTSperm production reduced or absent
- 9. Non-obstructive AzoospermiaTesticular Sperm Aspiration - TESA
- 10. Non-obstructive AzoospermiaTesticular microdissection - micro-TESEMethod to identify site(s) of production
- 11. Based on the diameter of seminiferous tubules
- 13. Identify site of production
- 14. Preserve vasculature of testis
- 15. Small quantity of tissue excisedSchlegel, Hum Reprod 1999; 14
- 17. Esteves, AndrofertSperm Retrieval Rates in NOA are Related to Testicular Histopathology but not to the Etiology of AzoospermiaEsteves SC, Verza Jr S, Prudencio C, Seol B; FertilSteril 2010 176 NOA men (mean age 36.9 years)
- 18. Microdissection TESE or TESA
- 19. Classified according to the Etiology of NOA
- 20. Biopsy for histology concomitant or prior to SRHypospermatogenesis (HYPO)Maturation Arrest (MA)Sertoli Cell Only Syndrome (SCO)
- 21. SpermRetrievalandEtiologyof NOAEtiologyChi-square; NSEsteves SC, Verza S, Prudencio C, Seol B. Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia. FertilSteril. 2010;94(Suppl.):S132.
- 22. Esteves, AndrofertSpermRetrieval in NOA isrelatedtoTesticular HistopathologyEsteves SC et al FertilSteril 2010; 94:S132Results (2): Micro-TESE X TESA*TESA vs micro-TESE (MA + SCO): P=.03
- 23. Micro-TESE39%P=.03Micro-TESETESA/TESEN=131; *hypospermatogenesis excludedEsteveset al.; FertilSteril 2010; 94:S132
- 24. Esteves, AndrofertPredictive Factors for Sperm Retrieval in NOAChance of finding sperm is dependent on the most advanced site of spermatogenesis within the testisFSHInhibinBTesticular volumeEtiologyTestosterone levelsTestis histology Reflect global spermatogenic function but not the most advanced site of sperm production in a dysfunctional testis
- 25. Predictive Factors for Sperm Retrieval in NOAY Chromosome MicrodeletionAZFa deletedGerm cell AplasiaNo retrievable spermAZFb deletedMaturation Arrest No retrievable spermAZFc deletedHypospermatogenesis70% chance of retrieving testicular sperm for ICSI
- 26. Esteves, AndrofertPESA/MESATESA/TESELaboratory Sperm Processing for ICSI
- 27. PESA/MESA
- 28. TESA
- 29. TESE
- 30. Esteves, AndrofertReproductive Potential of Azoospermic Men in ART
- 31. SpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjectionVerza Jr S & Esteves SC; IntBraz J Urol 2008; 34Not statistically different
- 32. Esteves, AndrofertSpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjectionVerza Jr S & Esteves SC; IntBraz J Urol 2008; 34Not statistically different
- 33. Esteves, AndrofertSpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjectionVerza Jr S & Esteves SC; IntBraz J Urol 2008; 34* P<0.05
- 34. Sperm Retrieval Rates and Reproductive Potential of Azoospermic Men in ICSIPrudencio C, Seoul B, Esteves SC. Reproductive potential of azoospermic men undergoing intracytoplasmic sperm injection is dependent on the type of azoospermia.FertilSteril 2010; 94 (4): Suppl. S232-233.
- 35. Sperm Retrieval TechniquesPractical PointsObstructive AzoospermiaSperm retrieval and lab processing simple
- 36. Sperm obtained in virtually all cases
- 37. Chance of Retrieval and ICSI Outcomes:
- 38. Independent on obstruction etiology
- 39. Independent on retrieval technique
- 40. Independent on sperm source
- 41. Results similar or better than ejaculated spermSperm Retrieval TechniquesPractical PointsNon-obstructive AzoospermiaSperm production deficient or absent
- 42. Overall, retrieval rates ~50%
- 43. Labor-intensive lab sperm processing
- 44. Retrieval rates dependent on technique
- 45. Micro-TESE yields better SRR
- 46. Predictive factors: testis histology & Y-chromosome
- 47. Reproductive potential by ICSI lower than OA and non-azoospermic men