Fine Needle Aspiration Mapping Research Articles

PD58-08 FNA MAPPING-GUIDED SPERM RETRIEVAL VS. UPFRONT MICROTESE IN NON-OBSTRUCTIVE AZOOSPERMIA: A COMPARISON OF SPERM RETRIEVAL, PREGNANCY AND LIVE BIRTH RATES FROM A HIGH VOLUME FERTILITY CENTER

You have accessJournal of UrologyInfertility: Therapy II (PD58)1 Apr 2020PD58-08 FNA MAPPING-GUIDED SPERM RETRIEVAL VS. UPFRONT MICROTESE IN NON-OBSTRUCTIVE AZOOSPERMIA: A COMPARISON OF SPERM RETRIEVAL, PREGNANCY AND LIVE BIRTH RATES FROM A HIGH VOLUME FERTILITY CENTER Akash A. Kapadia*, Marah Hehemann, David Ball, Robert D. McClure, Kevin Ostrowski, and Thomas J. Walsh Akash A. Kapadia*Akash A. Kapadia* More articles by this author , Marah HehemannMarah Hehemann More articles by this author , David BallDavid Ball More articles by this author , Robert D. McClureRobert D. McClure More articles by this author , Kevin OstrowskiKevin Ostrowski More articles by this author , and Thomas J. WalshThomas J. Walsh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000968.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 50% of men with non-obstructive azoospermia (NOA) experience sperm retrieval (SR) failure even with microTESE. No clear predictors of SR have been established that may obviate invasive, costly surgery in men (microTESE) and their female partners (oocyte retrieval). Testicular fine needle aspiration mapping (FNAM) is an office procedure that provides highly accurate data on spermatogenesis. No study has directly compared outcomes of FNAM-guided SR to upfront microTESE. The primary outcomes are SR, pregnancy, and livebirth rates using upfront FNAM vs upfront microTESE from 3 providers with different practice patterns at a single high-volume fertility center. Our secondary objective is to describe utilization rates of SR techniques guided by FNAM. METHODS: We performed a review of males at our clinic diagnosed with NOA from 2009-2019. Treatment pathways were delineated: A) FNAM-guided SR, B) upfront microTESE. Corresponding female partners’ records were reviewed for pregnancy and livebirth data. χ2 analyses were performed for SR, pregnancy and livebirth rates. RESULTS: Of 96 men with NOA, 60 underwent FNAM (Group A), and 36 had upfront microTESE (Group B) based on surgeon and patient preferences. In Group A, 34/60 (56.7%) patients had FNA maps positive for spermatogenesis. Of these, 19/34 (55.9%) had diffuse hypospermatogenesis, and 15/34 (44.1%) had focal hypospermatogenesis. 31/34 (91.1%) underwent SR, 3 declined further treatment. 18/31 (58.1%) had FNA-targeted TESA/E, and 13/31 (41.9%) had microTESE. SR was successful in 30 of 31 men (96.7%). Overall SR rate was 52.6% and 58.3% in groups A and B, respectively, resulting in no statistical difference (p = 0.59). Group A had pregnancy and livebirth rates of 33.3% and 28.1%, respectively. Group B had pregnancy and livebirth rates of 33.3% each. χ2 analysis revealed no statistical difference for both pregnancy (p = 1.0) and livebirth rates (p = 0.6). CONCLUSIONS: Rates of SR, pregnancy and livebirth are similar in the two groups. With FNAM, a majority of men with NOA were treated with minimally invasive, office-based SR. Upfront FNAM allowed for accurate counseling regarding SR success. Further in-depth cost analysis is needed to determine improved cost-efficiency with FNAM. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1202-e1203 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akash A. Kapadia* More articles by this author Marah Hehemann More articles by this author David Ball More articles by this author Robert D. McClure More articles by this author Kevin Ostrowski More articles by this author Thomas J. Walsh More articles by this author Expand All Advertisement PDF downloadLoading ...

Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm.

We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital “heat maps” revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

The value of testicular ‘mapping’ in men with non-obstructive azoospermia

As the field of assisted reproduction has advanced, many previously untreatable men are now biological fathers. Although finding sperm in men with obstructive azoospermia is not difficult, locating and retrieving spermatozoa in men with non-obstructive azoospermia remains a clinical challenge, largely because sperm production in these men can be patchy or focal in nature. In response to this challenge, strategies such as fine-needle aspiration (FNA) mapping have been developed to find spermatozoa. This review discusses the history, evolution and current clinical utility and findings with FNA mapping for male infertility). Review of the current literature in the English language on FNA (diagnostic or therapeutic) with a keyword focuses on sperm detection, retrieval, safety and complications. FNA was described in human medicine over 100 years ago. Testis FNA was described 45 years ago and FNA 'mapping' of spermatozoa was described in 1997. This comparative review of the literature on sperm detection and complication rates with FNA and open testis biopsy or microdissection procedures suggests that FNA is highly informative, minimally invasive and is associated with fewer complications than other commonly used approaches to sperm detection in non-obstructive azoospermic patients. FNA mapping has gained considerable traction as an informative, 'testis sparing' technique for sperm detection in non-obstructive azoospermia. With knowledge of sperm presence and location prior to sperm retrieval, FNA maps can help clinicians tailor sperm retrieval to optimize time, effort and extent of procedures needed to procure spermatozoa in these difficult cases.

Analysis of spermatogenesis in non-obstructive azoospermic and virtually azoospermic men with known testicular pathology

It is widely thought that human testicles affected by unilateral pathology will have greater impairment of spermatogenesis than the otherwise unaffected testis. This study reviewed records of non-obstructive azoospermic (NOA) and virtually azoospermic (NOVA) men with associated testicular pathology who underwent testicular fine needle aspiration (FNA) mapping. Concentration of spermatozoa found in each testis was analysed to discern sperm-lateralization patterns in affected and unaffected testes. A total of 1098 FNA sites from 56 men (32 varicocele, 16 cryptorchidism, three epididymo-orchitis, two mumps orchitis, three torsion) were analysed. Overall, 38 patients (68%) had spermatozoa detected in at least one testis. Most men (68%) had equal proportions of FNA sites showing spermatozoa from both testes, 29% had more spermatozoa from the unaffected testis and 3% had more spermatozoa from the affected testis. Significantly fewer sperm-positive sites were observed on the affected (272 out of 752) than unaffected side (164 out of 346) (P < 0.0001, chi-squared test). When assessed by FNA mapping, most NOA and NOVA men with known unilateral testis pathology will have equal proportions of spermatozoa in both testes. However, when sperm production differs between sides, the unaffected side is much more likely to have spermatozoa. This information may be used to refine sperm-retrieval strategies in selected patients.

MP-02.18: Comparison of systematic fine needle aspiration mapping and multiple microbiopsies of testis in evaluation of azoospermia

MP-02.18: Comparison of systematic fine needle aspiration mapping and multiple microbiopsies of testis in evaluation of azoospermia

Correlation of testis biopsy histology and fine needle aspiration in nonobstructive azospermia. The Buenos Aires 3 years experience

Correlation of testis biopsy histology and Fine Needle Aspiration Mapping in nonobstructive azospermia. The Buenos Aires 3 yearsExperience Objectives: To correlate the sperm finding from testicular biopsy to testis Fine needle aspiration (FNA) mapping in infertile men with nonobstructive azospermia (NOA). Design: Retrospective study of infertile men with NOA. Methods: Testis FNA mapping was performed concurrently with open “window” testis biopsies under local anesthesia in 34 men with NOA (sending to histology and criopreservation) over three year period at Hospital de Clinicas Jose de San Martin University Hospital . Results: A total of 35 patients were studied by biopsy and FNA. A mean number of 7 FNA sites and 1.0 biopsy per testes .Mature sperm with tails were detected by FNA in 17 patients (48.5%) compared to 12 patients (34.2%) by biopsy histology alone. In addition 2/5 men with a complete late maturation arrest (n=5 patients) histologic pattern had successful sperm retrieval by directed TESE after FNA suggested a focus of mature sperm. We consider late maturation arrest as a good predictor of finding sperm at the retrieval .Other histologic patterns encountered include early maturation arrest (n = 3 patients) and pure Sertoli cell only (n=10 patients in one of these patients were found 5 sperm with criopreservation). No complications were encountered in any patient. Conclusion: Our initial experience confirms the fact that a significant fraction of men with NOA can have sperm within the testis .In ours hands, FNA mapping appears more sensitive than open testis biopsy in the detection of mature sperm in these patients.

Characteristics of infertile men with intermittent non-obstructive complete asthenospermia

Objective: Male factor patients with a history of low sperm counts often exhibit low or absent motility. This variability in semen quality presents a clinical challenge during ART cycles as “back up” plans and procedures are necessary at the time of egg retrieval to ensure that viable sperm are available for ICSI. We present the clinical features, natural history and a management strategy, including the use of FNA mapping, in a cohort of intermittent nonobstructive asthenospermic patients. Design: Case controlled, retrospective review of a consecutive patients at a single institution. Materials and Methods: Over 2 years, 15 men presented with infertility characterized by intermittent complete asthenospermia, defined as at least 1 documented semen analysis showing motile sperm and another without. All patients underwent formal evaluation with history, physical exam, semen with centrifuged pellet analysis, and hormones. In addition, patients were offered fine needle aspiration (FNA) mapping to localize testis sperm prior to IVF-ICSI. Semen quality at ICSI and the need for “back up” TESA/TESE procedures were assessed. Results: Prior paternity was documented in 3/15 (20%) patients. Medical diagnoses included varicocele (5/15, 33%), idiopathic (4/15, 27%), diabetes (2/15, 13%), DES exposure (2/15, 13%), partial hypogonadotropic hypogonadism (1/15), and balanced translocation (1/15). Mean testis volumes were 15.6 mL on right and 14mL on left. Mean testosterone and FSH levels were 305 (normal 260–1000) and 9.7 (normal 1–8), respectively. Range of semen volume was 2–4.5mL, total sperm count was 10 sperm to 3 million sperm, and motility ranged from 0–50%. On pre-ICSI, FNA mapping (n=15 patients), mature sperm were found in 14/15 (93%) patients; 1 patient had elongated spermatids. Roughly half of testis maps showed an “even” sperm distribution in the testis and the other half showed “pockets” of sperm. The mean interval from FNA mapping to ICSI was 4.7 months (range 1–23 months). At ICSI (n=13 patients), sufficient motile ejaculated sperm were obtained in 5/13 (39%) patients (motile sperm count range: 20–400,000) and “back up” procedures were needed in 8/13 (61%) patients due to lack of motile sperm. ICSI “back up” procedures included unilateral TESA (n=3), bilateral TESA (n=2), bilateral TESE (n=1) and unilateral Micro-TESE (n=2) at which time sufficient sperm were found in 6/8 patients. Conclusion: Successful management of male infertility due to severe oligoasthenospermia is a complex challenge for ICSI programs. Among these patients, systemic medical diagnoses are likely present, and “back up” plans and procedures are likely to be employed at ICSI.

Efficiency of Percutaneous Testicular Sperm Aspiration as a Mode of Sperm Collection for Intracytoplasmic Sperm Injection in Nonobstructive Azoospermia

Efficiency of Percutaneous Testicular Sperm Aspiration as a Mode of Sperm Collection for Intracytoplasmic Sperm Injection in Nonobstructive Azoospermia

Correlation of testis biopsy histology and fine needle aspiration mapping in nonobstructive azoospermia: the Buenos Aires experience.

Correlation of testis biopsy histology and fine needle aspiration mapping in nonobstructive azoospermia: the Buenos Aires experience.

Impaired spermatogenesis in men with congenital absence of the vas deferens

It is generally assumed that men with congenital bilateral absence of the vas deferens (CBAVD) have azoospermia because of obstruction and that sperm production is normal. This study examines spermatogenesis in men with CBAVD to assess the validity of this assumption. We identified all men with CBAVD who had undergone either a diagnostic or therapeutic fertility procedure. Procedures included diagnostic biopsy, testis fine needle aspiration (FNA) mapping, microscopic epididymal sperm aspiration (MESA), and testis sperm extraction (TESE). Among 33 CBAVD men, 18 underwent testis biopsy, 27 had MESA/TESE, and 10 had FNA mapping. On evaluation of these procedures, normal spermatogenesis was present in 29 men. Four men (12%) demonstrated impaired spermatogenesis. One patient had FNA testis cytology consistent with late maturation arrest, another demonstrated hypospermatogenesis on biopsy and low sperm yield by MESA, and two patients had pure Sertoli cell only histology on biopsy. Aetiologies for impaired spermatogenesis included varicocele and underlying genetic abnormalities. Although patients with CBAVD are assumed to have normal spermatogenesis and infertility due simply to obstruction, the potential for concomitant defects in sperm production exists. A clinical suspicion of testis failure should prompt further diagnostic evaluation of spermatogenesis prior to sperm retrieval. In addition, genetic counselling should be offered and testing for genetic lesions, including cystic fibrosis gene mutations and/or variants, Y chromosome microdeletions, and karyotype abnormalities, should be considered.

Testicular fine-needle aspiration in infertile men: correlation of cytologic pattern with biopsy histology.

Open testicular biopsy is the standard method for histopathologic assessment of spermatogenesis. The need for testis biopsy has been questioned with the increased success of minimally invasive techniques such as fine-needle aspiration (FNA) mapping. This study examines whether FNA can provide cytologic information equivalent to histologic patterns by correlating diagnoses from testis FNA cytology with biopsy histology. Men (n = 87) who had undergone both diagnostic FNA mapping and open testis biopsy in the evaluation of infertility were identified. Biopsies were assessed by recognized histologic patterns of normal, hypospermatogenesis, early and late maturation arrest, and Sertoli cell only. FNA cytologic specimens were examined for adequacy and were classified similarly. Mixed patterns were also identified. The correlation between the two methods was 94%, with no differences among the different histologies. Discrepancies between cytology and histology were primarily the result of inadequate sampling and evidence of mixed patterns on FNA mapping. FNA cytology is a minimally invasive method of obtaining testicular tissue for diagnostic purposes. These data demonstrate that FNA cytology can evaluate accurately all classically defined histologic types, and may have the potential to replace testis biopsy in the assessment of spermatogenesis.

Relationship between classic histological pattern and sperm findings on fine needle aspiration map in infertile men.

Systematic testis fine needle aspiration (FNA) mapping has been proposed as an adjunctive or alternative diagnostic procedure to biopsy to determine the presence of spermatozoa within infertile testes. This study related testis histology to the global presence or absence of spermatozoa in the same testes determined by FNA cytology. Testis biopsies and FNA mapping were performed in 87 infertile, azoospermic men. A mean of 1.3 biopsies and 14 FNA sites were taken per patient. Biopsies were assessed by recognized histological patterns of normal, Sertoli cell-only, hypospermatogenesis, early and late maturation arrest, sclerosis as well as mixed patterns that included at least two of these histologies. FNA cytological specimens were assessed for sperm presence by an experienced cytologist. Overall, spermatozoa were found by FNA mapping in 52% of patients. A comparison of histology and FNA findings revealed that pure patterns of Sertoli cell-only and early maturation were associated with a very poor likelihood of sperm detection (4-8%). In contrast, patients with other pure pattern histologies or mixed patterns had high rates of FNA sperm detection (77-100%). Similar to reported testicular sperm extraction (TESE) findings, sperm detection with FNA shows wide variation depending on testis histology. Unlike most TESE reports, however, some histological patterns generally reflect a more global testicular dysfunction and poorer likelihood of sperm identification, suggesting the possibility that these phenotypes have a genetic origin. Systematic testis sampling with FNA offers additional geographical information about spermatogenesis that routine biopsies lack and can further guide couple decision-making in severe male factor infertility.

DIAGNOSTIC FINDINGS FROM TESTIS FINE NEEDLE ASPIRATION MAPPING IN OBSTRUCTED AND NONOBSTRUCTED AZOOSPERMIC MEN

Although helpful for defining extratesticular obstruction, the testis biopsy offers limited information on nonobstructive azoospermic testes. Guided by diagnostic biopsies, testis sperm extraction procedures fail in 25% to 50% of patients with nonobstructive azoospermia, largely because it is clinically difficult to know where sperm are located. To provide a more complete assessment of spermatogenesis in nonobstructive azoospermic patients and to simplify the confirmation of sperm production in men with obstruction, we use a systematic, fine needle aspiration "mapping" procedure. We summarize the diagnostic findings in a series of azoospermic men. From 118 azoospermic infertile men (22 with obstructed and 96 with nonobstructed azoospermia) fine needle aspiration data were used to generate location specific, sperm frequency maps for obstructed and nonobstructive azoospermic testes to determine if "sperm rich" locations existed. Fine needle aspiration map analysis revealed that all aspiration locations from obstructed cases showed sperm. In men with nonobstructive azoospermia, sperm was identified in the right testis in 134 of 652 (20.5%) and in the left testis in 151 of 716 (21.1%) separate aspirations. Rates of sperm detection among various intratesticular sites were not statistically different. In 27.1% of cases the fine needle aspiration map found sperm in men with sperm negative biopsies. The likelihood of heterogeneity in fine needle aspiration sperm findings was 25% within individual nonobstructive azoospermic testes and 19.2% between testis sides. At post-procedure followup of 88 patients (74%), no clinical or surgical complications were observed. Testis fine needle aspiration mapping is a simple, reliable and informative diagnostic tool in the evaluation of azoospermic infertile men.

Compound genetic factors as a cause of male infertility: Case Report

A 40 year old healthy Chinese male with primary infertility was seen in a university male infertility and genetic counselling clinic. He presented with congenital bilateral absence of the vas deferens (CBAVD) and the finding of testis atrophy. Fine needle aspiration mapping of the testis identified and localized sperm production within the testicles for in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Careful evaluation of testicular cytology revealed late maturation arrest of spermatogenesis. Cystic fibrosis gene mutation analysis revealed heterozygosity for the 5T variant within the polypyrimidine tract of intron 8. Cytogenetic analysis revealed a pericentric inversion of chromosome 6 with break points at p12 and q21 [46,XY,inv(6)(p12q21)]. This case illustrates that spermatogenesis is not necessarily normal with congenital bilateral absence of the vas deferens. Compound genetic defects may coexist and underlie male infertility.

Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine-needle aspiration mapping in patients with nonobstructive azoospermia

Objective: To evaluate intracytoplasmic sperm injection (ICSI) outcomes in a cohort of men with nonobstructive azoospermia who underwent prior fine-needle aspiration (FNA) “maps” to localize sperm and guide testis sperm extraction (TESE). Design: Retrospective clinical study. Setting: University-based infertility practice. Patient(s): A consecutive cohort of 19 infertile, azoospermic men. Intervention(s): Couples underwent IVF-ET in which TESE procedures were informed and directed by prior FNA maps of the testis. Main Outcome Measure(s): Sperm retrieval and pregnancy rates. Result(s): In 21 IVF-ET and ICSI cycles, sufficient sperm for all oocytes were retrieved in 20 TESE attempts (95%). A mean of 3.1 biopsies per patient were required, with an average size of 72 mg. Mean operative time for the TESE procedure was 88 minutes. Overall, the two-pronuclear fertilization rate was 66%; ongoing clinical pregnancies were obtained in 10 of 21 initiated cycles (48%). Conclusion(s): In an effort to reduce IVF-ET cancellation rates in cases of nonobstructive azoospermia, diagnostic testis FNA can define those patients who are good candidates for TESE. It also directs sperm retrieval and minimizes tissue removal from nonobstructed testes.

Systematic fine-needle aspiration of the testis: Correlation to biopsy and results of organ “mapping” for mature sperm in azoospermic men

Objectives This study compares fine-needle aspiration (FNA) and testis biopsy for the ability to detect mature sperm in the testes of azoospermic men. In addition, we introduce the concept of testis “mapping” with FNA and apply it to detect sperm in men with severe testis failure. Methods Sixteen patients were evaluated for azoospermia in a university-based infertility clinic. All men had testis biopsies and FNAs from matched testicular sites to assess for the presence of spermatozoa. Adequacy criteria for FNA specimens were strictly defined, and correlative analysis of the two techniques was performed. In addition, a subset of 12 men with nonobstructive azoospermia (NOA) had systematic FNA mapping (more than four FNA sites per testis) to detect mature sperm for potential clinical use. Results Adequate FNA specimens were obtained in 115 (91.3%) of 126 FNA attempts. Of 34 paired biopsy FNA sites, FNA was seen to be more sensitive than, and equally specific as, testis biopsy for sperm detection. When compared with the biopsy touch imprint, FNA was equally as sensitive and specific. Among men with NOA who underwent FNA mapping, 4 (33%) of 12 had localized “patches” of sperm detected in areas distant from sperm-negative biopsy sites. In 1 case, a pregnancy was achieved with later biopsy and sperm extraction “directed” by previous FNA. Conclusions For sperm detection, testis FNA provides equivalent or better information than a testis biopsy. FNA can localize areas of sperm production within the testis and accurately guide sperm extraction procedures in men with NOA.