Sperm Retrieval Techniques Research Articles

The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians.

Male infertility represents a significant global problem due to its essential health, social, and economic implications. It is unsurprising that scientific research is very active in this area and that advances in the diagnostic and therapeutic fields are notable. This review presents the main diagnostic advances in male infertility, starting from the changes made in the latest WHO Manual of semen analysis and discussing the more molecular aspects inherent to "omics". Furthermore, the usefulness of artificial intelligence in male infertility diagnostics and the latest advances in varicocele diagnosis will be discussed. In particular, the diagnostic path of male infertility is increasingly moving towards a personalized approach to the search for the specific biomarkers of infertility and the prediction of treatment response. The treatment of male infertility remains empirical in many regards, but despite that, advances have been made to help formulate evidence-based recommendations. Varicocele, the most common correctable cause of male infertility, has been explored for expanded indications for repair. The following expanded indications were discussed: elevated sperm DNA fragmentation, hypogonadism, orchalgia, and the role of varicocele repair in non-obstructive azoospermia. Moving forward with the available data, we discussed the stepwise approach to surgical sperm retrieval techniques and the current measures that have been investigated for optimizing such patients before testicular sperm extraction. Finally, the key points and expert recommendations regarding the best practice for diagnosing and treating men with infertility were summarized to conclude this review.

Historical perspective of surgical sperm retrieval techniques for nonobstructive azoospermia.

Historical perspective of surgical sperm retrieval techniques for nonobstructive azoospermia.

Clinical predictors of successful outcomes for couples with nonobstructive azoospermic male partners undergoing micro-TESE.

Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.

Male infertility: an overview of etiology, diagnosis and management

Male infertility, a multifaceted condition characterized by the inability to achieve pregnancy within a partner after a year of unprotected intercourse, affects approximately 7% of men globally. The etiology of male infertility is diverse, including genetic abnormalities, hormonal imbalances, physical obstructions, and lifestyle factors. This review synthesizes current knowledge on the causes, diagnostic methods, and therapeutic interventions for male infertility, with an emphasis on recent advances in genetic and assisted reproductive technologies (ART). The diagnostic approach to male infertility involves a comprehensive evaluation, including semen analysis, hormonal profiling, genetic testing, and imaging techniques, to identify underlying causes. Management strategies range from lifestyle modifications and pharmacological treatments to surgical interventions and ART, such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Emerging technologies, including the use of artificial intelligence in semen analysis and the development of novel sperm retrieval techniques, promise to enhance diagnostic accuracy and treatment outcomes. Despite significant progress, challenges remain in improving access to care and addressing ethical considerations in the use of ART. This review highlights the importance of a multidisciplinary approach to the management of male infertility, integrating advances in medical science with considerations of patient well-being and ethical standards. Future research directions include elucidating the genetic basis of idiopathic male infertility, optimizing ART outcomes, and developing personalized treatment strategies. The ultimate goal is to improve the reproductive health and quality of life for affected individuals and couples.

Microsurgical Testicular Sperm Extraction: Predictive Factors and Outcomes for Men with Nonobstructive Azoospermia

Background. Nonobstructive azoospermia (NOA) is a frequent cause of male infertility, and microsurgical testicular sperm extraction (micro-TESE) is an effective technique for sperm retrieval in NOA cases. However, the predictive factors for successful sperm retrieval and the outcomes of micro-TESE in NOA patients are not fully understood. Methods. In this retrospective study, we evaluated the predictive value of preoperative data and outcomes of micro-TESE in 172 men with NOA who underwent the procedure between April 2012 and February 2021. Patients’ age, medical history, testicular size, hormonal profile, testicular histology, and sperm retrieval were recorded. Results. 172 cases of micro-TESE were performed (99 unilateral and 73 bilateral) and testicular sperm retrieval rate (SRR) was 72.7%. There was no statistical difference in age, testicular size, and hormonal profiles between positive SRR and negative SRR groups. Clinical varicocele and previous orchitis did not significantly affect the result of micro-TESE. Y chromosome microdeletions were detected in seven patients. On histological examination, hypospermatogenesis was found in 39% of patients who underwent testicular biopsy. SRR was higher in patients with hypospermatogenesis than in other groups. Conclusions. Testicular microdissection is an effective and safe procedure for nonobstructive azoospermia patients, regardless of the different etiologies and preoperative data. Age, testicular size, and hormonal levels did not predict the success of micro-TESE. The presence of hypospermatogenesis was associated with a higher SRR. Clinical varicocele and previous orchitis were not significantly associated with the outcome of micro-TESE.

Ex vivo microscopic testicular sperm extraction at the time of radical orchiectomy in men with nonobstructive azoospermia (NOA): a scoping review.

Testicular tumor is the most common solid malignancy in males under 40 years of age. This malignancy is known to have a negative impact on male fertility. Therefore, several techniques for sperm retrieval have been proposed, including microdissection testicular sperm extraction (mTESE). The objective of this study was to review the literature on the outcomes of oncological (Onco)-mTESE at the time of radical orchiectomy. We conducted a comprehensive literature search through PubMed, Scopus, and Cochrane Central Controlled Register of Trials. Only studies reporting ex vivo mTESE in patients with testicular tumor were considered. Twelve papers met the inclusion criteria and were included in this review. Tumor size was identified as the sole preoperative factor influencing spermatogenesis. The considered studies demonstrated a satisfactory success rate for Onco-mTESE, associated with a similarly valid percentage of live healthy births through assisted reproductive technology. Currently, no comparison has been made between Onco-mTESE and conventional Onco-TESE, hence further assessment is required. In cases where the tumor completely replaces the cancer-bearing testicle, a contralateral micro-TESE may be a viable alternative. However, the surgeon should evaluate associated risks and benefits preoperatively. In conclusion, Onco-mTESE at the time of radical orchiectomy appears to be a promising therapeutic option for young patients with testicular tumors. Nevertheless, additional studies are necessary to achieve a definitive conclusion.

Micromapping testicular sperm extraction: A new technique for microscopic testicular sperm extraction in nonobstructive azoospermia.

In microscopic testicular sperm extraction (mTESE) for nonobstructive azoospermia (NOA), sperm can be recovered relatively easily in some cases, and mTESE may be retrospectively considered excessive. However, mTESE is routinely performed in the majority of NOA patients because of the difficulty in predicting tissue status. A minimally invasive and comprehensive sperm retrieval method that allows on-the-spot tissue assessment is needed. We have developed and evaluated a novel sperm retrieval technique for NOA called micromapping testicular sperm extraction (MMTSE). MMTSE involves dividing the testis into four sections and making multiple small needle holes in the tunica albuginea to extract seminiferous tubules and retrieve sperm. The sperm-positive group by MMTSE (Group I) underwent additional tissue collection (ATC) via a small incision, whereas the sperm-negative group by MMTSE (Group 0) underwent mTESE. In total, 40 NOA participants underwent MMTSE. Group I included 15 patients and Group 0 included 25 patients. In Group 1, sperm were recovered from all patients by ATC. In Group 0, sperm were recovered in 4 of 25 cases using mTESE. MMTSE shows promise as a simple method that comprehensively searches testicular tissue and retrieves sperm using an appropriate method while minimizing patient burden.

Surgery for Obstructive Azoospermia

Microsurgical technique in male infertility has progressed significantly since the introduction of intracytoplasmic sperm infection (ICSI) 30 years ago. The searching of sperm available for ICSI becomes the main tasks for reproductive andrologists. At the initial study for patients with azoospermia, it is crucial to differentiate obstructive causes from non-obstructive categories. Testis biopsy is still a gold standard testing method to confirm obstructive azoospermia (OA). For patients with OA, the choice spectrum of treatment is broad. Basically, sperm can be retrieved from anywhere upstream the blocking spot along the male reproductive tract. However, it is not always that infertile couples consider ICSI as their treatment of choice. The choice of treatment should be prioritized according to patients’ concerns. The concerns include age of female partner, the patency of oviducts, the presence of infection in the seminal plasma, DNA fragmentation index of sperm, failure of prior use of downstream sperm for in vitro fertilization (IVF) or ICSI, religious limitation, economical affordability, number of babies expected and techniques available from the surgeons. For techniques view, the surgeons should be equipped with capabilities of techniques for sperm retrieval from the testis (testicular sperm extraction, abbreviated TESE) and epididymis (percutaneous epididymal sperm extraction abb. PESA; or microscopic epididymal sperm aspiration abb. MESA). Besides, techniques of microsurgical anastomosis of vas (vasectomy reversal or vaso-vasostomy) and epididymal tubule (vaso-epididymostomy) after scrotal exploration are also required. Other special conditions of obstructive azoospermia are also included, such as congenital absence of vas deferens (CBAVD) or causes for dry ejaculation (including diabetes neuropathy, or post retroperitoneal surgery), or obstruction of ejaculatory ducts. Herein, I would like to share the experiences on treatment of various types of obstructive azoospermia, via scrotal exploration and the techniques of epididymovasostomy. Besides, different techniques of sperm retrieval like MESA and TESE are also demonstrated.

P-089 effect of testis tissue retrieval on “Micro Mapping Testicular Extraction” (MMTE): comparison with microscopic testicular sperm extraction (Micro TESE) in non-obstructive azoospermia (NOA)

Abstract Study question Is a new sperm retrieval method, Micro Mapping Testicular Extraction (MMTE) comparable to that of Microscopic testicular sperm extraction (Micro TESE)? Summary answer MMTE is comparable to that of Micro TESE regarding sperm retrieval rate (SRR). It can reduce tissue damage and improve intracytoplasmic sperm injection (ICSI) results. What is known already Micro TESE is currently the standard technique for sperm retrieval in NOA. However, the large incision severely damages testicles, complicating repeated Micro TESE, and there is a high risk of testicular atrophy and hypogonadism. New technologies, such as FNA mapping, have also been reported, but these require multiple surgeries, long operation times, and high examination costs. A more accurate and minimally invasive method of sperm retrieval is needed, using a shorter and simpler procedure. Study design, size, duration MMTE requires only a small amount of testicular tissue, obtained through multiple needle holes in the tunica albuginea by micro-squeezing under a microscope. Tissue is divided into four testicular areas: ventral-upper, ventral-lower, dorsal-upper, and dorsal-lower, and samples are immediately searched for sperm. If sperm are found, a small incision is made in the area with good sperm and additional tissue is taken under the microscope. If no sperm are found, routine Micro TESE is performed. Participants/materials, setting, methods From January to November 2022, 25 NOA cases (35.9+/-4.85 years) with indications for Micro TESE were eligible: 15 idiopathic, 6 gr/gr deletion, 2 Klinefelter’s syndrome, 1 b2b4 deletion and 1 other. MMTE was performed on 45 testes: 5 unilateral (Group A) cases and 20 bilateral (Group B) cases. If sperm were found, they were cryopreserved and later used or will be used for ICSI. Main results and the role of chance After MMTE, sperm were found in all 5 cases in Group A. In group B, sperm were found in 6 cases after MMTE. For those sperm positive 11 cases, additional sampling was performed to gain enough sperm for ICSI. Micro TESE was performed for the rest of group B (14 cases, 28 testes), in which no sperm was found by MMTE. Of 2 cases out of 14 cases, only a few sperm were found by Micro TESE. No sperm was found in the rest of 12 cases. As a result, the SRR per patient was 52% (13/25). The weight of tissue sampled was 56.2 mg (15.6-96.2 mg) by MMTE and 224.6mg (206.4-433.2 mg) by Micro TESE, a significant difference. (p < 0.05). To date, ICSI has been performed in the MMTE-positive 11 cases with a partner (33.8+/-3.4 years). In those cases, the fertilization rate was 62.7% (79/126). The blastocyst rate was 31.7% (40/126), and the pregnancy rate per transfer was 75% (6/8). The total testosterone levels before and 1 month after surgery were significantly reduced only in the cases in which no sperm were found by MMTE. Limitations, reasons for caution Two cases that were sperm-positive only by Micro TESE had severe tissue degeneration and tissue was difficult to retrieve from needle holes, so countermeasures were necessary. It is necessary to consider the number of needle holes depending on the size of the testis. The number of cases is still small. Wider implications of the findings MMTE can correct tissue just under the albuginea and can cover areas that are difficult to reach with Micro TESE. The sample can be taken through a small incision, so tissue damage is limited to that of Simple TESE, which improves ICSI results by taking sperm from the best areas. Trial registration number non applicable

P-143 Will Use of Testicular sperm in ICSI cycles increase Embryo Aneuploidy?

Abstract Study question Will use of surgically retrieved Testicular Sperms (TESA) in Intra-Cytoplasmic Sperm Injection (ICSI) cycles increase embryo aneuploidy? Summary answer Use of TESA sperms for ICSI seems safe and doesn’t increase embryo aneuploidy. TESA performed for various indications also showed no variation with embryo aneuploidy. What is known already Invention of ICSI and improved surgical sperm retrieval techniques have helped men with severe male factor infertility to father their own genetic child. Sperms retrieved from seminiferous tubules of testes are considered immature as they haven’t completed the process of spermiogensis. It is hypothesized that use of TESA sperm for ICSI can increase embryo aneuploidy, which is still uncertain. Study design, size, duration This retrospective study conducted at a private fertility clinic from 2014–2022 (n = 265 patients; total of 860 embryos evaluated). Study populationTESA sperm used and PGT-A done (n = 66). TESA group was further sub-divided into 2 groups based on the indication for TESA,Non-Obstructive Azoospermia(n = 26) and Raised SDF(n = 40). Control Population Ejaculated sperm used and PGT-A done (n = 199) Only younger women(<37yrs) with self-gametes and RIFconsidered in this study. RIF was defined as women with 2 failed IVFcycles in thepast with at least 4 blastocystsbeing transferred. Participants/materials, setting, methods All fertilized oocytes inseminated by ICSI and subjected to extended blastocyst culture. TESA done as per our clinic’s SOP and for control group sperm preparation done by density gradient method. Trophectoderm biopsy was performed and sent for PGT-A to the genetic lab. Next-Generation sequencing (NGS) was the Comprehensive Chromosomal technique (CCS) used for assessing embryo ploidy status. Aneuploidy across all groups compared. Main results and the role of chance Following were the Aneuploidy rates of TESA sperm, Ejaculate sperm group and TESA done for NOA and SDF respectively. Ejaculate Sperm – Aneuploidy%- 42% TESA Sperm (irrespective of the indication)- Aneuploidy%- 44% (p = 0.6260) TESA Sperm (done for NOA)- Aneuploidy%- 44% (p = 0.7504) TESA Sperm (done for raised SDF) – Aneuploidy%- 32% (p = 0.05) Embryo aneuploidy was comparable between Ejaculate and TESA sperm group. Though TESA sperm is considered immature, it didn’t seem to increase embryo aneuploidy. Embryo Aneuploidy from TESA sperm ICSI cycles done for NOA or raised SDF also showed no altering trend. Data from this study is suggestive that TESA sperm doesn’t alter embryo ploidy status. Limitations, reasons for caution Data is retrospective with small sample size and unequal distribution. A well designed Randomized Trial might help test the inference of this study further. Wider implications of the findings Incidence of male infertility and use of ICSI is on a rise globally. Interventions to optimize embryo implantation and reproductive outcomes will help with better success rates and shorten duration to conception. Further research is warranted with severe male factor infertility to improve sperm selection techniques and reproductive outcomes. Trial registration number not applicable

P-030 Clinical outcomes of microdissection testicular sperm extraction (micro TESE) and intracytoplasmic sperm injection (ICSI) in non-obstructive azoospermia (NOA) with the history of cryptorchidism

Abstract Study question What is sperm retrieval rate (SRR) by micro TESE and the clinical outcomes using testicular sperm in couples with the history of cryptorchidism? Summary answer NOA couples with the history of cryptorchidism had a higher SRR by micro TESE but lower clinical outcomes by ICSI compared of unexplained NOA. What is known already Undescended testis (UT) which is exposed to a higher temperature compared with the scrotal temperature is associated with impairment of germ cell maturation, and progressive Leydig and Sertoli cell atrophy, and subsequent infertility in adulthood. There have been very few studies of ICSI with a focus on, or large enough numbers to examine, the specific outcomes associated with male factor infertility, however improvement in sperm retrieval techniques including micro TESE and micromanipulation techniques, such as ICSI, has led to excellent fertilization and pregnancy outcomes of treatment cycles. Study design, size, duration We performed a retrospective study based on two reproduction centers in Japan and evaluated 1521 azoospermic patients in our clinics between September 2013 and December 2022. We investigated SRR by micro TESE in these patients and therefore aimed to evaluate the prevalence and the significance of ICSI outcomes with embryonic development in NOA couples with the history of cryptorchidism. Participants/materials, setting, methods We evaluated SRR of micro TESE, two pronuclei (2PN) oocyte rates, blastocyst development, good-quality blastocyst (Grade 3BB and above on day 5 by the Gardner scoring), and clinical pregnancy rates per embryo transfer (ET) in 72 NOA cases with the history of UT, 953 cases of unexplained NOA, not including after orchidopexy, Klinefelter syndrome, cryptozoospermia, mumps orchitis, and 284 cases of obstructive azoospermia (OA). Statistical analysis was performed using unpaired t-tests and chi-squared tests. Main results and the role of chance SRR of first attempt micro TESE in UT (44/56=78.6%) was higher than unexplained NOA (160/748=21.4%) (p < 0.001). Spermatozoa were successfully retrieved in 13 of 22 (59.1%) UT group and 36 of 226 (15.9%) unexplained NOA who had previously undergone micro TESE with no sperm found. No correlation was found between serum FSH, LH, and T level with the success of sperm retrieval. Testicular volume and patient age at orchidopexy also did not affect the SRR for micro TESE. 2PN oocytes, blastocysts development, and good-quality blastocysts rates were 45.5%, 47.4%, and 18.9% in UT, 51.2%, 45.0%, and 20.9% in unexplained NOA, and 62.6%, 52.1%, and 23.7% in OA, respectively. Clinical pregnancy rates per ET were 29.3% in UT, 32.3% in unexplained NOA, and 41.6% in OA. Significant differences were only observed in 2PN oocytes between unexplained NOA and OA (p < 0.05) and clinical pregnancy between UT and unexplained NOA (p < 0.05), and OA and unexplained NOA (p < 0.01). Several UT patients showed a very small number of spermatozoa and even only immotile sperm of retrieved by micro TESE. Limitations, reasons for caution We included the patients only after a surgery of cryptorchidism, but not a delayed testicular descent without surgery. The cohort size of this study is not small, however, our screened population of azoospermic patients may be biased. Wider implications of the findings This study shows a high impact in micro TESE and ICSI outcomes with embryonic development for the NOA couples with the history of cryptorchidism. Our study emphasizes that history of cryptorchidism provides clinically valuable prognostic information to couples considering surgical sperm retrieval. Trial registration number not applicable

Microdissection testicular sperm extraction outcomes in azoospermic patients with bilateral orchidopexy.

Cryptorchidism is considered to be one of the most common causes of non-obstructive azoospermia. There are several surgical techniques to retrieve sperm in these patients. Microdissection testicular sperm extraction (m-TESE) is a recent sperm retrieval technique which is considered to be a safe, non-blind, and feasible method. This study aimed to investigate sperm retrieval rate (SRR) by the mTESE method in patients who have undergone orchidopexy due to bilateral cryptorchidism. In this retrospective study, 56 ex-cryptorchid patients, who underwent mTESE due to post orchidopexy azoospermia, were included. Patients with hypogonadotropic hypogonadism, Klinefelter syndrome, azoospermia factors (AZF) microdeletion, or chromosomal translocation were excluded from the study. Data were obtained from medical files. SRR in this study was 46%. Patients were divided into two groups of negative (n=30) and positive (n=26) based on the sperm extraction outcomes. There was no statistically significant difference between two groups regarding the mean age at mTESE, mean age at orchidopexy, testicular size, and serum testosterone concentration. However, testicular location, histological patterns, FSH, and LH level showed to have statistically significant relation with sperm retrieval results. But, according to our logistic regression, none of the included variable in the model including FSH, LH, histopathology, and testis location have a significant effect on the presence of the sperm. In the present study, SRR was significantly higher in patients with scrotal testis and low level of FSH and LH. Performing mTESE could be recommended in ex-cryptorchid patients with post orchidopexy NOA. Preoperative testicular biopsy seems to be unnecessary while clinical criteria can perfectly define NOA.

A comprehensive examination of post-mortem sperm retrieval techniques - A review article

A comprehensive examination of post-mortem sperm retrieval techniques - A review article

WHAT IS THE BEST TECHNIQUE TO RECOVER SPERMATOZOA FROM OBSTRUCTIVE AZOOSPERMIC PATIENTS?

Verify which sperm retrieval technique is more effective, by comparing reproductive outcomes, for men who have azoospermia due to obstructive causes.

Testicular microdissection following failed sperm aspiration: a single-center experience.

Azoospermia is a cause of infertility in a subgroup of infertile men. Sperm retrieval techniques including testicular sperm aspiration (TESA) and microscopic testicular sperm extraction (mTESE) are widely used. In this study, we have reviewed our findings regarding mTESE performed following a negative TESA outcome. This is a retrospective chart review study that included 41 infertile patients who underwent mTESE after a negative TESA outcome. Charts were reviewed for demographic data, type of infertility, and type of azoospermia. Hormone level analysis was done for follicle-stimulating hormone, luteinizing hormone, and testosterone. Testicular volume was estimated by ultrasound. The study included 41 patients who underwent mTESE following a negative TESA outcome. Most patients had primary infertility (n = 32; 78%). Of the 41 patients, four had a previous history of either TESE or orchidopexy, and two had a history of varicocelectomy before the recent percutaneous TESA procedure. There was no significant association between sperm retrieval and the different surgical procedures that had been performed. Of the 41 patients, 27 had positive sperm retrieval by mTESE with a success rate of 65.9%. The positive sperm retrieval rate of mTESE performed following a negative TESA outcome was reasonable (65.9%). No significant correlations were identified with all variables studied.

CLINICAL OUTCOMES OF MICRODISSECTION TESTICULAR SPERM EXTRACTION (MICRO TESE) AND INTRACYTOPLASMIC SPERM INJECTION (ICSI) IN NON-OBSTRUCTIVE AZOOSPERMIA (NOA) WITH THE HISTORY OF CRYPTORCHIDISM

Undescended testis (UT) is associated with impairment of germ cell maturation and subsequent infertility in adulthood. The undescended testis is exposed to a higher temperature compared with the scrotal temperature and there is progressive Leydig and Sertoli cell atrophy. There have been very few studies of ICSI with a focus on, or large enough numbers to examine, the specific outcomes associated with male factor infertility. Improvement in sperm retrieval techniques including micro TESE and micromanipulation techniques, such as ICSI, has led to excellent fertilization and pregnancy outcomes of treatment cycles.

P-018 Serum Follicle-Stimulating Hormone (FSH) levels as a predictor of outcomes after Surgical Sperm Retrieval (SSR) for male infertility

Abstract Study question Is there an association between pre-operative FSH levels and successful outcomes following Surgical Sperm Retrieval (SSR), and subsequent fertility treatment? Summary answer Higher levels of pre-operative FSH are associated with unsuccessful SSR, and, in the cases of successful retrieval, sperm less likely to produce healthy live births. What is known already Surgical Sperm Retrieval (SSR) techniques combined with Intracytoplasmic Sperm Injection (ICSI) offer men with azoospermia a chance to father biological children. However, the variable success rates of these physically, psychologically, and financially costly procedures highlights the potential value of pre-operative predictors of success. A literature review indicated serum FSH a promising pre-operative prognostic factor. However, only very few papers investigated pregnancy outcomes as an endpoint. Study design, size, duration An extensive literature review was undertaken examining literature between 2015-2020. This led to determination of the serum cut-off level to apply to the different groups’ outcomes. The study was a retrospective clinical analysis of SSR offered by a university Hospital between 2014-2021. Sample size was 118 (mainly Testicular Sperm Aspiration (TESA) and Percutaneous Epididymal Sperm Aspiration (PESA) patients. Patients with Klinefelter’s (KF) (N = 3) were excluded from analysis due to the genetic nature of their azoospermia. Participants/materials, setting, methods Databases from the University Hospital's Theatres and Andrology Department provided data on patients who underwent SSR 2014-present. A retrospective evaluation of physical and electronic notes identified preoperative hormone profiles and other potential influencers. Pregnancy outcomes were ascertained from the ICSI and Frozen Embryo transfer (FET) databases. Using a serum FSH cut-off of 15IU/mL (chosen based on previous literature review) data was analysed for differences between the groups’ outcomes. ROC analysis generated potential alternate cut-offs. Main results and the role of chance Using the initial 15IU/mL cut-off analysis demonstrated significantly more patients had unsuccessful SSR and sperm that did not produce healthy live birth where FSH was ≥15IU/mL at a 95% confidence level. The ROC curves for both SSR and pregnancy outcomes also proved significant – suggesting various potential cut-offs from our data. One potentially valuable cut-off for identifying men unlikely to produce sperm capable of producing a healthy live birth following all treatment is 14.0IU/mL (FSH above this predicting failure in pregnancy outcomes) (sensitivity 40.8%, specificity 90.5%), i.e., above this level the model predicts 90.5% of men will not have success. The lower bound 95% CI for this curve was above 0.5, indicating the curve to be statistically significant at a 95% confidence level. Limitations, reasons for caution SSR is rare and a lack of documentation available for some patients resulted in a relatively small sample size. Our data comprises primarily TESE and PESA patients. Different surgeon technique or service standards may influence outcomes. Our findings did not consider KF patients, who may have favourable SSR outcomes. Wider implications of the findings SSR is a costly procedure financially and physically with variable success rates. Hopefully these findings can help counsel men as to their likelihood of success in having a healthy live birth following SSR and subsequent treatment, helping to reduce both a financial burden on services and emotional burden on patients. Trial registration number Not applicable

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not.

The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.

Does testicular sperm retrieval adversely impact spermatogenesis over the long-term?

Testicular sperm retrieval (TSR) techniques are valuable in the context of severe idiopathic male factor infertility; however, there are few studies in the literature examining the long-term impact of TSR on testicular function. The objective was to determine whether testicular sperm aspiration (TESA) or microdissection testicular sperm extraction (micro-TESE) worsens the pre-existing spermatogenesis deficiency in men with either cryptozoospermia or severe oligozoospermia. The study population consisted of 145men with either cryptozoospermia or severe oligozoospermia that underwent TESA or micro-TESE and had long-term post-operative semen analyses (SA). Patients with SA prior to and following TSR were included (n=24). Amongst them, 16men underwent TESA and 8 underwent micro-TESE. The follow-up SA was obtained at a mean of 3.0±2.0years following TSR (range: 0.3-8.3years) amongst all participants. The post-operative semen parameters in the TESA group were similar to the pre-intervention parameters (p>0.1). Similarly, the micro-TESE cohort did not demonstrate significant alterations in semen parameters post-intervention (p>0.05). None of the men in the study became azoospermic following the TSR. Our study indicates TESA or micro-TESE do not appear to worsen the pre-existing spermatogenesis deficiencies in cryptozoospermic and oligozoospermic men over a long-term period. Larger studies are required to corroborate these findings.

Методики получения сперматозоидов у пациентов с необструктивной азооспермией

Patients with non-obstructive azoospermia (NOA), which accounts for up to 10-15% of all cases of male infertility, until recently could only become parents using donor sperm or through adoption. Modern technical capabilities of sperm extraction in combination with the use of assisted reproductive technologies, make it possible to effectively overcome infertility in this group of patients. A number of highly effective techniques have been proposed for spermatozoa retrieval. However, surgical intervention is associated with certain risks, and therefore, the choice of the optimal treatment method is under discussion. A total of 52 articles were analyzed using the MEDLINE database (PubMed) to form an overview of the current principles of examination and preparation of a patient with NOA for the surgical sperm retrieval. This review is dedicated to the role of diagnostic testicular biopsy. In addition, a comparative information on the efficacy and safety of percutaneous, fine-needle aspiration, open multifocal and microdissection (micro-TESE) testicular biopsies is presented. Of the currently available sperm retrieval techniques in the urologic armamentarium, micro-TESE seems to be both the most effective and the safest. Micro-TESE can be a cumbersome procedure, however, it provides successful treatment in situations previously associated with zero chance of pregnancy.