Abstract
Intracytoplasmic sperm injection (ICSI) has allowed reproduction options through assisted reproductive technologies (ARTs) for men with no spermatozoa within the ejaculate (azoospermia). In men with non-obstructive azoospermia (NOA), the options for spermatozoa retrieval are testicular sperm extraction (TESE), testicular sperm aspiration (TESA), or micro-surgical sperm extraction (microTESE). At the initial time of spermatozoa removal from the testis, spermatozoa are immobile. Independent of the means of spermatozoa retrieval, the subsequent steps of removing spermatozoa from seminiferous tubules, determining spermatozoa viability, identifying enough spermatozoa for oocyte injections, and isolating viable spermatozoa for injection are currently performed manually by laboratory microscopic dissection and collection. These laboratory techniques are highly labor-intensive, with yield unknown, have an unpredictable efficiency and/or success rate, and are subject to inter-laboratory personnel and intra-laboratory variability. Here, we consider the potential utility, benefits, and shortcomings of developing technologies such as motility induction/stimulants, microfluidics, dielectrophoresis, and cell sorting as andrological laboratory add-ons to reduce the technical burdens and variabilities in viable spermatozoa isolation from testicular samples in men with NOA.
Highlights
non-obstructive azoospermia (NOA) BackgroundClinical infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regularly unprotected sexual intercourse [1]
Reproductive Sciences Program, Departments of Obstetrics/Gynecology, Physiology, and Urology, University of Michigan, Ann Arbor, MI 48103, USA
non-obstructive azoospermia (NOA) is considered the most severe and difficult form of azoospermia to treat with assisted reproductive technologies (ARTs) for at least three primary reasons: (1) the method of gamete retrieval; (2) the variable and unpredictable degree of compromised spermatogenesis and success of spermatozoa retrieval/isolation; (3) the initial non-motile nature of retrieved testicular sperm
Summary
Clinical infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regularly unprotected sexual intercourse [1]. NOA is considered the most severe and difficult form of azoospermia to treat with assisted reproductive technologies (ARTs) for at least three primary reasons: (1) the method of gamete retrieval; (2) the variable and unpredictable degree of compromised spermatogenesis and success of spermatozoa retrieval/isolation; (3) the initial non-motile nature of retrieved testicular sperm. In contrast to TESE and TESA, microTESE is another form of spermatozoa isolation in NOA This procedure involves a urologist/surgeon bisecting the testis and using surgical microscopy and 15–20× magnification to identify and isolate dilated/plump seminiferous tubules. Though this surgical procedure is considered more invasive than TESE and TESA, it is a regionally selective biopsy of visualized and isolated seminiferous tubules—resulting in less tissue removal and the ability for spermatozoa identification from isolated tubules to be confirmed by an andrologist in the surgical suite. The success of spermatozoa isolation from microTESE-isolated seminiferous tubules was shown to be highest in cases of dilated/plump tubule selective biopsy (90%) versus non-dilated tubule removal (7%) [16]
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