Abstract
Retrieving spermatozoa from the testicles has been a great hope for patients with non-obstructive azoospermia (NOA), but relevant methods have not yet been developed to the level necessary to provide resolutions for all cases of NOA. Although performing testicular sperm extraction under microscopic magnification has increased sperm retrieval rates, in vitro selection and processing of quality sperm plays an essential role in the success of in vitro fertilization. Moreover, sperm cryopreservation is widely used in assisted reproductive technologies, whether for therapeutic purposes or for future fertility preservation. In recent years, there have been new developments using advanced technologies to freeze and preserve even very small numbers of sperm for which conventional techniques are inadequate. The present review provides an up-to-date summary of current strategies for maximizing sperm recovery from surgically obtained testicular samples and, as an extension, optimization of in vitro sperm processing techniques in the management of NOA.
Highlights
To date, testicular spermatozoa from patients with non-obstructive azoospermia (NOA) have been used widely for intracytoplasmic sperm injection (ICSI), this method’s effectiveness still has potential for further improvement
Increased spermatozoa retrieval rates (SRRs) 9% of cases where no spermatozoa were found after mechanical searching
The success of ICSI in patients with NOA is closely related to the recovery of motile spermatozoa during testicular sperm extraction (TESE)
Summary
Testicular spermatozoa from patients with non-obstructive azoospermia (NOA) have been used widely for intracytoplasmic sperm injection (ICSI), this method’s effectiveness still has potential for further improvement. Its simpler and less traumatic features have made FNA the preferred method, testicular sperm extraction (TESE) is the treatment of choice for patients with NOA, with a satisfactory number of successful spermatozoa retrieved in approximately half of the patients. A recent controlled, randomized study verified the efficacy of microTESE compared with that of TESE in retrieving spermatozoa from patients with NOA [8]. In addition to the surgical technique, in vitro extraction of sperm from surgically excised testicular tissue or tubules is important for obtaining spermatozoa of sufficient quality and quantity for use in ICSI
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