Testicular Sperm Retrieval Research Articles

Use of testicular sperm for ICSI in oligozoospermic couples: how far should we go?

In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental.

Testicular sperm extraction for patients with spinal cord injury-related anejaculation: A single-center experience.

To present a single-center experience with testicular sperm extraction and intracytoplasmic sperm injection for fathering biological children in patients with ejaculatory dysfunction as a result of spinal cord injury. Testicular sperm extraction was carried out in 52 male patients with ejaculatory dysfunction as a result of spinal cord injury. We investigated sperm retrieval rates and pregnancy rates from medical records. Data on age, testicular volume, hormonal status (luteinizing hormone, follicle stimulating hormone and testosterone), and time since spinal cord injury were obtained and analyzed to detect potential associations with the presence of spermatogenesis. Testicular sperm retrieval was achieved in 42 of 52 patients (80.7%). Intracytoplasmic sperm injection was carried out for 37 patients, and pregnancy was achieved in 32 (86.5%). The take-home baby rate was 70.2%. In the group with successful sperm extraction, testicular volume was significantly greater, time from spinal cord injury to extraction was significantly shorter, and serum luteinizing hormone and follicle-stimulating hormone levels were significantly lower. Serum follicle-stimulating hormone levels had the strongest association with feasibility of sperm retrieval by testicular sperm extraction. Furthermore, the sperm retrieval rates of patients injured within the preceding 12 years were significantly better than those injured longer before treatment (P = 0.045). Testicular sperm extraction and intracytoplasmic sperm injection seem to provide favorable results for patients with ejaculatory dysfunction as a result of spinal cord injury. However, early testicular sperm extraction is recommended, because sperm retrieval becomes more difficult with time from spinal cord injury.

Alterations of testis-specific promoter methylation in cell-free seminal deoxyribonucleic acid of idiopathic nonobstructive azoospermic men with different testicular phenotypes

To explore the feasibility of quantification of testicular DNA methylation from cell-free seminal DNA (cfsDNA), and analyze promoter methylation alterations in men with idiopathic nonobstructive azoospermia (NOA). Comparison between testicular DNA and paired cfsDNA, and among NOA patients with different testicular phenotypes. Academic research institute and andrology practice. Eighty-eight idiopathic NOA patients with different testicular phenotypes and 24 normozoospermic men. Testicular biopsies and semen analysis. Five testis-specific methylated promoters were selected. Promoter methylation was quantified using MethyLight in testicular DNA and paired cfsDNA, and the mRNA level was determined by real-time quantitative polymerase chain reaction. Correlations of methylation of the selected five promoters between testicular DNA and paired cfsDNA were observed; and promoter methylation was negatively related to the messenger RNA level in testis. The cfsDNA methylation of these promoters showed different dynamic changes among the subtypes of NOA and normozoospermia. Among them, CCNA1 and DMRT1 promoter methylation in the hypospermatogenesis group was higher than in other groups and showed diagnostic potential for the patient with hypospermatogenesis. Cell-free seminal DNA could be a novel, noninvasive biomarker for the detection of testicular epigenetic aberrations. Epigenetic information in cfsDNA related to spermatogenesis may serve to predict successful testicular sperm retrieval in NOA patients.

Expression level of chromodomain Y (CDY): potential marker for prediction of sperm recovery in non-obstructive azoospermia

The availability of testis specific genes will be of help in choosing the most promising biomarkers for the detection of testicular sperm retrieval in patients with non-obstructive azoospermia (NOA). Testis specific chromodomain protein Y 1 (CDY1) is a histone acetyltransferase which concentrates in the round spermatid nucleus, where histone hyperacetylation occurs and causes the replacement of histones by the sperm-specific DNA packaging proteins, TNPs and PRMs. The aim was to evaluate CDY1 gene as a marker for predicting of successful sperm retrieval in NOA patients. This research was conducted on 29 patients with NOA who had undergone testicular sperm extraction (TESE) procedure. NOA patients were subdivided into patients with successful sperm retrieval (NOA+, n=12) and patients with unsuccessful sperm retrieval (NOA-, n=17). Relative expression of CDY1 gene and chromatin incorporation of CDY1 protein were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and ELISA assay, respectively. Quantification of mRNA relative expression and incorporation of CDY1 protein in chromatin showed significant lower expressions and protein levels of CDY1 in testis tissues of NOA- in comparison to NOA+ group. The findings in this study demonstrated a correlation between the low levels of CDY1 function and unsuccessful sperm recovery in the testicular tissues of NOA- compared to NOA+ patients. Therefore, it can be reasonable to consider CDY1 as a potential biomarker for predicting the presence of spermatozoa, although the claim needs more samples to be confirmed.

A novel stepwise micro-TESE approach in non obstructive azoospermia

BackgroundThe purpose of the study was to investigate whether micro-TESE can improve sperm retrieval rate (SRR) compared to conventional single TESE biopsy on the same testicle or to contralateral multiple TESE, by employing a novel stepwise micro-TESE approach in a population of poor prognosis patients with non-obstructive azoospermia (NOA).MethodsSixty-four poor prognosis NOA men undergoing surgical testicular sperm retrieval for ICSI, from March 2007 to April 2013, were included in this study. Patients inclusion criteria were a) previous unsuccessful TESE, b) unfavorable histology (SCOS, MA, sclerahyalinosis), c) Klinefelter syndrome. We employed a stepwise micro-TESE consisting three-steps: 1) single conventional TESE biopsy; 2) micro-TESE on the same testis; 3) contralateral multiple TESE.ResultsSRR was 28.1 % (18/64). Sperm was obtained in both the initial single conventional TESE and in the following micro-TESE. The positive or negative sperm retrieval was further confirmed by a contralateral multiple TESE, when performed. No significant pre-operative predictors of sperm retrieval, including patients’ age, previous negative TESE or serological markers (LH, FSH, inhibin B), were observed at univariate or multivariate analysis. Micro-TESE (step 2) did not improve sperm retrieval as compared to single TESE biopsy on the same testicle (step 1) or multiple contralateral TESE (step 3).ConclusionsStepwise micro-TESE could represent an optimal approach for sperm retrieval in NOA men. In our view, it should be offered to NOA patients in order to gradually increase surgical invasiveness, when necessary. Stepwise micro-TESE might also reduce the costs, time and efforts involved in surgery.

Infertilidad masculina asociada a las microdeleciones del cromosoma Y. Opciones reproductivas y riesgos de la descendencia

Y-chromosome microdeletions are currently one of the most common causes of male infertility. The absence of some genes located in certain regions in the long arm of the human Y-chromosome, known as azoospermia factor region, causes spermatogenic failure, while spermatozoa has been found in either the ejaculate or the testicle of most patients. Detection of deletions is crucial for the medical treatment of these patients, since it has a prognostic value in predicting potential success of testicular sperm retrieval in azoospermic patients with certain microdeletions, and allows avoiding invasive techniques in oligozoospermia patients whose sperm production could result in progressive worsening.Intracytoplasmic sperm injection, together with testicular or epididymal sperm retrieval for azoospermic men, has allowed these patients to become fathers using their own gametes, but the ability to vertically transmit that genetic defect, and thus, the infertility, to the offspring has been commonly accepted. Until recently, no clinical consequences other than infertility were supposed in the sons of fathers with deletions. However, different studies in the last few years suggest other potentially risks transmitted to the offspring, such as development of sexual dysfunction due to sex chromosome abnormalities (Turner or Klinefelter syndromes) or other somatic disorders, with worse health consequences, caused by chromosome aberrations in autosomes associated with Y-chromosome microdeletions. To date, no major clinical complications other than infertility have been described in the offspring born from fathers with deletions, but it is important to remember that the first generation of those babies has just reached maturity. Moreover, the aforementioned chromosome anomalies could halt embryo development or increase miscarriage rate, reducing the chances of a successful pregnancy in affected couples attending infertility clinics. Therefore, the actual risk of transmitting different anomalies associated to microdeletions to the offspring should be clarified in order to establish the most appropriate treatment for these patients.

The probability of obtaining testicular sperm in cases of cryptozoospermia

Cryptozoospermia is the finding of rare sperm on extensive evaluation of semen in men with nonobstructive azoospermia (NOA). When insufficient sperm numbers, or only immotile sperm, are found in semen at IVF-ICSI, testicular sperm retrieval (TESE) is often considered as a “back up” sperm source (1). However, TESE procedures in cryptozoospermic men can fail due to the “patchy” or focal nature of sperm production in NOA testes. We evaluated the utility of sperm fine needle aspiration (FNA) “mapping” to locate testicular sperm in men with cryptozoospermia.

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis.

The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69–4.14; P < 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92–4.65; P = 0.08; live birth rate OR: 2.19; 95% CI: 0.99–4.83; P = 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%–55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair.

MP74-12 IS THERE ANY ROLE OF MEDICAL TREATMENT OR VARICOCELE REPAIR IN INFERTILE MEN WHO FAILED INITIAL TESTICULAR SPERM EXTRACTION?

You have accessJournal of UrologyInfertility: Therapy1 Apr 2015MP74-12 IS THERE ANY ROLE OF MEDICAL TREATMENT OR VARICOCELE REPAIR IN INFERTILE MEN WHO FAILED INITIAL TESTICULAR SPERM EXTRACTION? Selahittin Çayan, Abdullah Tok, and Turan Çetin Selahittin ÇayanSelahittin Çayan More articles by this author , Abdullah TokAbdullah Tok More articles by this author , and Turan ÇetinTuran Çetin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Empirical medical therapy and varicocele repair have been controversial in infertile men with non-obstructive azoospermia. In addition, no evidence based medical treatment has been included to induce spermatogenesis in men who failed initial testicular sperm extraction (TESE) procedure. The aim of this study was to investigate whether there is any role of medical treatment or varicocele repair in azoospermic men who had previous negative TESE procedure. METHODS During a 4 years period, the study included 181 azoospermic men, who failed TESE procedure, who then underwent repeat micro-TESE procedure. All patients were evaluated and treated by a single clinician. The patients were divided into 6 groups according to treatment type. Of the patients, 76 had clinical palpable varicocele on either one or both sides, and 105 had no varicocele. Of the 76 patients with varicocele, 58 had microsurgical subinguinal varicocele repair (Vx): 42 had additional medical treatment (recombinant HCG, anastrozol, or clomiphene citrate), and 16 were followed without additional medical therapy. Eight patients received medical therapy with no Vx treatment, and 10 were only followed with no medical and Vx treatment. Of the 105 men with no clinical varicocele, 90 received medical therapy, and 15 were followed with no treatment. Sperm retrieval rates on micro-TESE were compared according to the treatment groups. RESULTS The mean age was 33.44±6.82 years (21-51), and mean treatment duration prior to re-do micro-TESE was 10.4±3.42 months (6-24). Testicular sperm retrieval rates were 30.9% (13/42) in the men with varicocele who had Vx repair+medical treatment, 12.5% (1/8) in the men with varicocele who had no Vx treatment, but medical treatment, 18.7% (3/16) in the men with varicocele who had only Vx treatment with no medical treatment, 0% (0/10) in the men with varicocele who were followed with no Vx treatment or medical treatment, 18.8% (17/90) in the men with no varicocele who had only medical treatment, and 6.7% (1/15) in the men with no varicocele who were followed only with no medical treatment. CONCLUSIONS Benefit of pre-medical treatment prior to micro-TESE is limited in selected cases. Men with varicocele who failed initial TESE had higher sperm retrieval rate with varicocele repair than men having no varicocele repair. The highest sperm retrieval rate was achieved with varicocele repair plus medical treatment with recombinant HCG. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e943-e944 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Selahittin Çayan More articles by this author Abdullah Tok More articles by this author Turan Çetin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcome of microsurgical testicular sperm extraction in familial idiopathic nonobstructive azoospermia.

The aim of the study was to evaluate the sperm retrieval rate by microsurgical testicular sperm extraction (TESE) in familial idiopathic nonobstructive azoospermia (NOA). One hundred and nineteen patients with idiopathic NOA who underwent microsurgical TESE over the past 5 years were included. Patients were then divided into two groups; Group 'A' with familial idiopathic NOA (11 families with two brothers in each family, 22 patients) and Group 'B' with nonfamilial idiopathic NOA (97 patients). Clinical data as well as data of microsurgical TESE were recorded. In Group 'A', the sperm retrieval rate was 9.1% (2/22 patients) compared to 45.4% in Group 'B' (44/97 patients) (P ≤ 0.05). The two patients in Group 'A' with successful sperm retrieval belonged to one family. The histopathological diagnosis was the same in the brothers in each family. It can be concluded that the testicular sperm retrieval rate in familial idiopathic NOA is significantly lower than in nonfamilial idiopathic NOA.

Detection and Management of Obstructive Azoospermia

IntroductionObstructive azoospermia represents a treatable form of male factor infertility. With greater demand for assisted reproductive technologies the general urologist may be tasked with initiating the infertility evaluation and providing counsel for treatment options. In this review we discuss appropriate laboratory, radiographic and genetic testing for the patient with obstructive azoospermia. We also outline surgical treatment options. MethodsThe Medline® database was searched for relevant studies of the evaluation and treatment of men with obstructive azoospermia. Key words included obstructive azoospermia, vasovasostomy, vasoepididymostomy, testicular sperm extraction, sperm aspiration and sperm retrieval. ResultsMost published reports were based on small cohorts followed at single institutions. There were sufficient data to characterize the current state of the art and review the standard of practice. ConclusionsThe initial evaluation of azoospermia is primarily based on differentiating obstructive from nonobstructive etiologies with a substantial reliance on history, physical examination and screening laboratory studies. Various treatment options exist for obstructive azoospermia, including reproductive tract reconstruction (vasovasostomy or vasoepididymostomy) or numerous surgical sperm extraction approaches.

Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia: a systematic review and meta-analysis.

Noninvasive parameters for predicating sperm retrieval rate (SRR) are desirables. Follicle-stimulating hormone (FSH) has been an important predictor since the first years of testicular sperm extraction. Recent studies showed continuous interests in FSH, with both pros and cons. Thus, we conducted a meta-analysis to evaluate the diagnostic value of FSH as a predictor for patients with nonobstructive azoospermia (NOA) taking testicular sperm retrieval. Eligible diagnosis tests were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. The database search, quality assessment, and data extraction were performed independently by two reviewers. The reference standard was the sperm retrieval result. Diagnostic value of FSH were explored by area under receiver operation characteristics (ROC) curve using Review Manager, version 5.1.0 (Cochrane Collaboration, Oxford, UK) and Meta-DiSc, version 1.4. Meta regression will be done if there is heterogeneity. Then, we find 11 tests including a total of 1350 patients met the inclusion criteria. Our pooled analysis showed that the area under ROC curve of FSH was 0.72 ± 0.04. Meta regression analyses showed that region and average age have an influence on the diagnostic value. FSH showed more diagnostic value with patients in East Asia and with younger patients. We concluded that FSH had moderate value in independently predicating SRR in men with NOA (area under curve >0.7). More detailed diagnosis tests should be anticipated in the future to confirm the diagnostic value of other noninvasive parameters.

Correlation between leptin content and sperm retrieval in cases of functional azoospermia

IntroductionTesticular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) became the preferable techniques for solving the problem of azoospermic men. Non-invasive techniques are needed to predict sperm retrieval chance before TESE to avoid the psychological and physiological problems that may be developed. AimTo investigate the correlation between serum, seminal and testicular leptin levels and sperm retrieval in functional azoospermic men. MethodsThe study included 61 men classified into 4 groups; normozoospermia (NOR), obstructive azoospermia (OA), positive non-obstructive azoospermia (NOA (+)) and negative non-obstructive azoospermia (NOA (−)). Blood FSH, LH, Prolactin, Free and Total testosterone levels plus serum and seminal leptin levels were measured for all groups. For azoospermic groups, TESE and testicular leptin level were applied. Main outcome measuresBoth OA and NOR groups were used as control groups. The prediction accuracy for FSH and serum, seminal and testicular leptin was compared by receiver operating characteristic (ROC) curve analysis. ResultsThere were no significant differences in serum leptin levels among the four groups. Azoospermic groups showed higher seminal leptin levels than the NOR group. Seminal and Testicular leptin levels of NOA (−) men were significantly increased in comparison with OA and NOA (+) men. There was a significant negative correlation between serum leptin and total testosterone concentrations, and a significant positive correlation between testicular and seminal leptin concentrations. In ROC curve; for differentiation between positive and negative NOA, areas under the curve (AUC) of testicular and seminal leptin were greater than that of serum leptin. The combination of seminal leptin with FSH gave AUC greater than that of FSH alone. ConclusionThere is a role for leptin in spermatogenesis, and seminal leptin can be used as a good assistant marker to increase the prediction accuracy for sperm retrieval in NOA men especially in combination with FSH.

Progressing management of non-obstructive azoospermia in the era of microdissection testicular sperm extraction.

Previously, it was absolutely impossible for azoospermic men to reproduce except in some obstructive azoospermic cases for whom reconstruction of the seminal pathway was successful. However, nowadays, intracytoplasmic sperm injection and microdissection testicular sperm extraction have brought about chances of biological paternity in some non-obstructive azoospermic men. It is almost 15 years since the first trials of testicular sperm retrieval using surgical microscopy for non-obstructive azoospermia were reported. In this manuscript, the progress and outcomes of these novel techniques since then are reviewed, the controversial points are discussed and the latest research to achieve pregnancies in tough non-obstructive azoospermic couples are introduced. Not only the bright side of the renovations, but the underlying concerns are also discussed.

Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1year of topical testosterone and aromatase inhibitor

Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1year of topical testosterone and aromatase inhibitor

Clinical relevance of Y-linked CNV screening in male infertility: new insights based on the 8-year experience of a diagnostic genetic laboratory

AZF microdeletion screening is routinely performed in the diagnostic work-up for male infertility; however, some issues remain debated. In this study, we provide insights into the sperm concentration cutoff value for routine testing, the predictive value of AZFc deletion for testicular sperm retrieval and the Y-background contribution to the interpopulation variability of deletion frequencies. In the Spanish population, partial AZFc rearrangements have been poorly explored and no data exist on partial duplications. In our study, 27/806 (3.3%) patients carried complete AZF deletions. All were azoo/cryptozoospermic, except for one whose sperm concentration was 2 × 10(6)/ml. In AZFc-deleted men, we observed a lower sperm recovery rate upon conventional TESE (9.1%) compared with the literature (60-80% with microTESE). Haplogroup E was the most represented among non-Spanish and hgr P among Spanish AZF deletion carriers. The analysis of AZFc partial rearrangements included 330 idiopathic infertile patients and 385 controls of Spanish origin. Gr/gr deletion, but not AZFc partial duplications, was significantly associated with spermatogenic impairment. Our data integrated with the literature suggest that: (1) routine AZF microdeletion testing could eventually include only men with ≤2 × 10(6)/ml; (2) classical TESE is associated with low sperm recovery rate in azoospermic AZFc-deleted men, and therefore microTESE should be preferred; (3) Y background could partially explain the differences in deletion frequencies among populations. Finally, our data on gr/gr deletion further support the inclusion of this genetic test in the work-up of infertile men, whereas partial AZFc duplications do not represent a risk for spermatogenic failure in the Spanish population.

Testicular sperm retrieval using a new multiple-holes puncture needle in TESA-ICSI patients

Testicular fine needle aspiration (TFNA) was initially used for diagnosis purposes and it is now sometimes used to recover sperm from the testicles for ICSI. This study was aimed to compare the reliability of testicular sperm extraction by a new multiple-hole needle aspiration (MHNA) with TFNA in infertile males with azoospermia. This retrospective cohort study involved 191 patients with azoospermia. Detailed clinical and laboratory examinations were performed and two semen analyses were obtained from each patient. A 20-ml 14 gauge 13-mm needle with multiple-hole was used for MHNA, and a 20-ml 21 gauge 13-mm needle was used for TFNA.Total 191 patients underwent testicular sperm retrieval were divided into two groups according to their sperm retrieval methods (MHNA group n=162; TFNA group n=29). The motile sperm retrieval rate in MHNA group was 65.4%, significantly higher than that in TFNA group of 44.5% (p<0.05). 64 TESA-ICSI cycles were performed in MHNA group, and 27 cases get clinical pregnant. Testicular MHNA in infertile males is a simple, reliable and minimally invasive technology for testicular sperm retrieval. It is more effective than TFNA in testicular sperm extraction.

Characteristics and outcomes of 499 consecutive cases of testicular sperm retrieval and ICSI for azoospermia in a Turkish state hospital-based art program

Characteristics and outcomes of 499 consecutive cases of testicular sperm retrieval and ICSI for azoospermia in a Turkish state hospital-based art program

Outcome of intracytoplasmic sperm injection cycles with fresh testicular spermatozoa obtained on the day of or the day before oocyte collection and with cryopreserved testicular sperm in patients with azoospermia

To compare the outcome of intracytoplasmic sperm injection (ICSI)-ET cycles with fresh testicular spermatozoa obtained on the same day or the day before oocyte retrieval with frozen-thawed spermatozoa. Retrospective cohort study. Fertility center. The first ICSI-ET cycle of 337 couples with motile testicular spermatozoa of azoospermic patients. Microdissection testicular sperm extraction (TESE), sperm cryopreservation, ICSI-ET. Fertilization, implantation, clinical pregnancy rates (PRs) and delivery rates. Testicular sperm retrieval was performed on the day of oocyte retrieval in 166 cycles (group A), the day before oocyte retrieval in 42 cycles (group B), and the frozen-thawed testicular spermatozoa were used in 129 cycles (group C). The groups were comparable in terms of the ages of male and female patients, ovarian response to stimulation, as well as the number of oocytes injected. The number of cycles with nonobstructive azoospermia and obstructive azoospermia was evenly distributed in each group. Fertilization rates were 70.7%, 68.7%, and 67.3%, clinical PRs 31.3%, 30.9%, and 25.5%, and delivery rates 28.9%, 28.5%, and 23.2% for groups A, B, and C, respectively. The outcomes of patients with nonobstructive azoospermia did not differ from those of patients with obstructive azoospermia within and among the groups. Neither the timing of TESE (on the day of or the day before oocyte retrieval) nor the use of frozen-thawed testicular sperm affects the outcome of ICSI-ET cycle when motile spermatozoa are obtained in azoospermic men. In addition, etiology of azoospermia does not have any influence on the outcome with different timing of microdissection TESE procedure for ICSI.

Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor

To evaluate surgical sperm retrieval rates in adolescents with Klinefelter syndrome and testosterone replacement therapy (TRT). Case series. Academic medical center. Ten patients with Klinefelter syndrome, aged 14-22 years, treated with testosterone replacement and aromatase inhibitor therapy for a period of 1-5 years before surgical sperm retrieval. Microsurgical testis sperm extraction with cryopreservation of harvested tissue. Presence of spermatozoa within testis tissue. Successful sperm retrieval in 7/10 patients (70%). Use of topical TRT did not appear to suppress spermatogenesis in adolescents with KS. It is uncertain whether sperm retrieval rates would be higher or lower without testosterone replacement in these young males. Sperm cryopreservation should be discussed in all KS adolescents who are either receiving or considering initiating TRT.