Abstract
Although the technique of intracytoplasmic sperm injection (ICSI) has been a revolution in the alleviation of male infertility, the use of testicular sperm for ICSI was a formerly unseen breakthrough in the treatment of the azoospermic man with primary testicular failure. At the clinical level, different procedures of testicular sperm retrieval (conventional TESE, micro-TESE, FNA/TESA, MESA, PESA) are being performed, the choice is mainly based on the cause of azoospermia (obstructive versus non-obstructive) and the surgeon’s skills. At the level of the IVF laboratory, mechanical procedures to harvest the sperm from the tissue may be combined with enzymatic treatment in order to increase the sperm recovery rates. A number of techniques have been developed for viable sperm selection in males with only immotile testicular sperm available. However, large, well-designed studies on the benefit and safety of one over the other technique are lacking. Despite all the available methods and combinations of laboratory procedures which have a common goal to maximize sperm recovery from testicular samples, a large proportion of NOA patients fail to father a genetically own child. Advanced technology application may improve recovery rates by detection of the testicular foci with active spermatogenesis and/or identification of the rare individual sperm in the testicular suspensions. On the other hand, in vitro spermatogenesis or sperm production from embryonic stem cells or induced pluripotent stem cells might be future options. The present review summarizes the available strategies which aim to maximize sperm recovery from surgically retrieved samples.
Highlights
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 was a major breakthrough in the treatment of male infertility [1], the successful use of epididymal and testicular sperm a few years later was a formerly unseen revolution in the treatment of the azoospermic man [2,3,4].Azoospermia, defined as the absence of spermatozoa in the ejaculate after assessment of centrifuged semen on at least two occasions, is observed in 1% of the general population and in 10–15% of infertile men [5]
While in Obstructive azoospermia (OA) a lot of sperm can be retrieved with epididymal aspirations (MESA, percutaneous epididymal sperm aspiration (PESA)), multiple testicular biopsies (TESE or micro-testicular biopsy retrieval (TESE)) is the retrieval procedure of choice in Non-Obstructive azoospermia (NOA) patients [7]
High sperm numbers can be retrieved with microsurgical epididymal sperm aspiration (MESA) in almost all patients with obstructive azoospermia, ICSI technique is more successful than conventional In Vitro fertilization (IVF) both in terms of fertilization and pregnancy rates [13]
Summary
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 was a major breakthrough in the treatment of male infertility [1], the successful use of epididymal and testicular sperm a few years later was a formerly unseen revolution in the treatment of the azoospermic man [2,3,4]. Azoospermia, defined as the absence of spermatozoa in the ejaculate after assessment of centrifuged semen on at least two occasions, is observed in 1% of the general population and in 10–15% of infertile men [5]. It can be clinically classified as either obstructive (OA, 40%) or non-obstructive azoospermia (NOA, 60%). More recent reviews which focus on only NOA concluded that microsurgical TESE may be associated with a higher recovery rate. The present review summarizes the evolution in the processing and selection of surgically retrieved sperm
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