Abstract
The treatment of men with non-obstructive azoospermia (NOA) has improved greatly over the past two decades. This is in part due to the discovery of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), but also significantly due to improvements in surgical sperm retrieval methods, namely the development of microdissection testicular sperm extraction (mTESE). This procedure has revolutionized the field by allowing for identification of favorable seminiferous tubules while simultaneously limiting the amount of testicular tissue removed. Improving sperm retrieval rates is imperative in this cohort of infertile men as there are a limited number of factors that are predictive of successful sperm retrieval. Currently, sperm retrieval in NOA men remains dependent on surgeon experience, preoperative patient optimization and teamwork with laboratory personnel. In this review, we discuss the evolution of surgical sperm retrieval methods, review predictors of sperm retrieval success, compare and contrast the data of conventional versus mTESE, share tips for optimizing sperm retrieval outcomes, and discuss the future of sperm retrieval in men with NOA.
Highlights
Introduction and Ettore CaroppoInfertility affects up to 15% of couples attempting to conceive globally, with a male factor implicated in up to 50% of cases [1]
While non-obstructive azoospermia (NOA) men currently rely on surgical sperm retrieval with assisted reproductive technology to father biological children, these men were historically relegated to using adoption or use of donor sperm to have a family [9]
It was not until 1995 that testicular sperm extraction (TESE), an open surgical procedure to directly extract testicular tissue, was performed on a man with NOA and testicular sperm utilized for successful in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) [15]
Summary
Infertility affects up to 15% of couples attempting to conceive globally, with a male factor implicated in up to 50% of cases [1]. While the precise etiology remains unclear in many of these cases, azoospermia, or the lack of sperm in the ejaculate, occurs in 1% of all males and 10–15% of infertile males and is often considered the most severe phenotype of male infertility classified as either obstructive azoospermia (30–40% of azoospermia cases) or non-obstructive azoospermia (NOA) (60–70% of azoospermia cases) [2,3,4,5,6]. NOA remains a challenging condition to treat as the majority of cases are idiopathic, with only a subset attributable to an identifiable genetic (i.e., Klinefelter Syndrome, Y-chromosome microdeletion or mutations in individual genes) or acquired (i.e., chemotherapy, radiation, cryptorchidism/prior orchiopexy or malignancy) condition [7,8]. NOA men require surgical retrieval of sperm with assisted reproductive technology to father children.
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