Abstract
INTRODUCTION AND OBJECTIVE: While surgical techniques for both testicular sperm extraction and microsurgical testicular sperm extraction have been well-established, the post-sperm extraction protocol varies between laboratories. We performed a comprehensive systematic review to assess the quality and efficacy of available protocols published in the literature. METHODS: Systematic review (MEDLINE/EMBASE/Cochrane Library/ClinicalTrials.gov) for studies reporting protocols for post-sperm extraction processing from database inception through 06/01/2019. Main outcomes/measures included successful sperm retrieval, sperm counts, sperm/grams of testicular tissue, and assessment of sperm stress/quality. Studies were excluded if the study was a case-report or did not report outcomes of post-sperm extraction protocol. Abstracts and peer-reviewed articles were both included. RESULTS: Our initial search provided 609 articles with summary data extracted from 13 included studies. Figure 1 details our PRISMA reporting diagram. Studies overall had a high risk of bias and a majority of studies did not employ adequate controls or comparison cohorts. No studies assessed sperm stress/quality. Studies highlighted different types of enzymatic digestion and/or mechanical maceration, angiocatheter pipetting, velocity sedimentation, fluorescence activated cell sorting, microfluidics, and a magnetic levitation platform for sperm processing. Given the vast heterogeneity and lack of comparison groups, a meta-analysis was not possible. The majority of studies employed some type of instrumentation maceration but studies using enzymatic digestion were also found to aid in sperm recovery. CONCLUSIONS: Samples in which sperm is not readily found often require processing to ensure that any sperm present is recovered. However, given the heterozygous nature of these samples, high risk of bias, and inconsistent reporting, further well-designed studies are necessary to determine optimal post-sperm extraction processing.Source of Funding: None
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