Testis Sperm Extraction Research Articles

NEWBORN RATE IS NOT IMPAIRED BY TIME FROM VASECTOMY, SMOKING AND BODY MASS INDEX (BMI) IN COUPLES WITH VASECTOMIZED MALE REQUIRING AN ASSISTED REPRODUCTIVE TECHNIQUE USING OOCYTE DONATION (OD)

The most employed definitive contraceptive method for men is vasectomy, although a non-negligible percentage of vasectomized men have regrets and express a renewed desire to have a child. In the case a relevant female factor infertility is present, OD has emerged the last years as a valid and widely employed option. In these cases, the main alternative is testis sperm extraction (TESE) together with intracytoplasmic sperm injection (ICSI) technique. To date there is little reports evaluating the clinical outcomes of vasectomized patients requiring the use of OD and the factors that may adversely affect reproductive outcome, such as time since the vasectomy, smoking or high BMI.

Intracytoplasmic Sperm Injection Outcomes with Freshly Ejaculated Sperms and Testicular or Epididymal Sperm Extraction in Patients with Idiopathic Cryptozoospermia.

BackgroundCryptozoospermia (CO) is a situation in which spermatozoa cannot be observed in a fresh semen sample unless an extended centrifugation and microscopic search are performed. CO patients are suggested to use only intracytoplasmic sperm injection (ICSI) as infertility treatment. But still there is debate about the choice of sperm source in cryptozoospermic men candidate for ICSI.ObjectivesThis study was conducted to evaluate fertility outcomes in men with idiopathic cryptozoospermia who were treated using ICSI with freshly ejaculated sperm and testis sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA).MethodsIn this prospective cohort study carried out in an academic institution, 83 out of 92 couples with cryptozoospermia undergoing their first ICSI cycle were recruited. These patients were randomly allocated to two groups: group one (n = 42) who produced freshly ejaculated sperm and, group two (n = 41) who produced a sample by TESE or PESA. The groups were analyzed and compared in terms of fertilization rate, cleavage rate, embryo quality, implantation rate, and clinical pregnancy rate.ResultsThere was a significant difference in fertilization rate, embryo quality, implantation rate, and pregnancy rates between the group of surgically extracted sperm and those of naturally ejaculated sperm using conventional ICSI (P < 0.05).ConclusionsSperm quality extracted by percutaneous PESA and TESE procedures increases fertility outcomes compared to naturally ejaculated sperm in men with idiopathic CO. More specifically, embryo quality, which is most relevant to fertility outcome, improved when surgically extracted sperm was used for ICSI.

Evaluation of testis sperm extraction (TESE) and testis histology in the gender confirming surgery patient

Patients undergoing gender confirming surgery (GCS) from male to female may consider initiating future fertility. WPATH guidelines recommend discussion of fertility early in protocol prior to transition. Little is known regarding spermatogenesis potential in male transsexuals treated with estrogen supplementation therapy (EST). Since sperm production is highly androgen dependent, use of EST preoperatively may affect spermatogenesis and maturation. Furthermore, there is scant literature regarding the testicular changes associated with EST, and there is no published literature assessing the role of sperm retrieval at the time of GCS.

048 Fertility Preservation in the Male to Female Transgender Patient: Role of Testis Sperm Extraction (TESE) and Testis Histology in Patients undergoing Gender Reassignment Surgery

048 Fertility Preservation in the Male to Female Transgender Patient: Role of Testis Sperm Extraction (TESE) and Testis Histology in Patients undergoing Gender Reassignment Surgery

MP91-11 REPRODUCTIVE KNOWLEDGE AND ATTITUDES OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation1 Apr 2016MP91-11 REPRODUCTIVE KNOWLEDGE AND ATTITUDES OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY Nelson Bennett, Alexander Muller, Patricia Guhring, and John Mulhall Nelson BennettNelson Bennett More articles by this author , Alexander MullerAlexander Muller More articles by this author , Patricia GuhringPatricia Guhring More articles by this author , and John MulhallJohn Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While sexual sequelae of radical prostatectomy (RP) are well appreciated and often discussed, infertility in this population is rarely written about in the literature. This analysis was undertaken to better understand the fertility discussion experience and attitudes of men undergoing RP. METHODS The population chosen for this analysis was men who had had a RP within the prior 6 months who were ≤50 years of age with a partner of reproductive age (≤45 years). Men were asked about their understanding of the impact of RP on their future fertility potential, whether they were advised to bank sperm, whether they actually banked sperm, and if they had not, their level of interest in sperm extraction post-RP. Patient and partner demographic data was recorded. Interest (pre or postop) was listed as no, maybe and yes. Multivariable model was constructed to look for predictors of interest in fertility in men undergoing RP. RESULTS 364 men were interviewed. Mean patient and partners age were 44±3 (38-50) years and 34±4 (32-42) years respectively. 58% of men could not recall ever being told about failure to ejaculate. With regard to interest in fertility; 11% said yes, 17% maybe, 72% no. 84% never appreciated banking preoperatively was an option, however, 20% of those definitely interested in fertility and 6% of those who might be interested actually banked semen. Only 8 men (2%) were aware that testis sperm extraction was a possibility post-RP. Predictors of yes/maybe interest in fertility were: young partner age, men without children, partner without children (see Table). CONCLUSIONS While the majority of younger men undergoing RP are not interested in fertility, a distinct minority are and appear to be poorly educated and prepared for fertility decisions before or after RP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1157 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nelson Bennett More articles by this author Alexander Muller More articles by this author Patricia Guhring More articles by this author John Mulhall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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.

2290 THE SEMEN ANALYSIS OUTCOMES OF TESTIS CANCER PATIENTS WITH AZOOSPERMIA PRIOR TO ORCHIECTOMY

You have accessJournal of UrologyInfertility: Evaluation1 Apr 20132290 THE SEMEN ANALYSIS OUTCOMES OF TESTIS CANCER PATIENTS WITH AZOOSPERMIA PRIOR TO ORCHIECTOMY Patrick Teloken, Darren Katz, Boback Berookhim, and John Mulhall Patrick TelokenPatrick Teloken New York, NY More articles by this author , Darren KatzDarren Katz New York, NY More articles by this author , Boback BerookhimBoback Berookhim New York, NY More articles by this author , and John MulhallJohn Mulhall New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2231AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testis cancer (TC) patients are at increased risk of sub-fertility prior to any intervention. Evidence suggests that improvement in semen parameters may occur after orchiectomy (O). This analysis was undertaken to assess the effects of orchiectomy in the semen analysis of men with TC who were diagnosed with azoospermia (AZ). METHODS A review of records of patients meeting the following criteria was conducted: (i) documented AZ prior to orchiectomy for the management of TC (ii) no prior paternity (iii) no TESE performed at time of O and (iv) semen analysis after O but prior to any further intervention. For patients with post-O AZ and with ≤1 million (M) sperm/ml, testis sperm extraction (TESE) was performed. Testis cancer histopathology, hormonal profile (total testosterone, TT; follicle stimulating hormone, FSH), semen and TESE data were recorded. Multivariable analysis was performed in an attempt to identify predictors of sperm return the ejaculate or retrieval on TESE after O. Factors included in the model were: patient age, serum T and FSH levels, testis volume, type of TC. RESULTS Thirty-six patients were included. Mean age = 34±16 years. Mean volume of unaffected testis = 16±8 ml. Sixty-eight percent of men had a seminoma while the remainder had a non-seminomatous germ cell tumor (NSGCT). Mean post-O TT was 364±168 ng/dl and FSH 11±4 IU/ml. Twenty-wo (61%) patients remained AZ after O, but 14 (39%) had return of some sperm to their semen; 22% ≤1M/ml and 17% >1M/ml (mean 4.2±3.6, range 1.6-8). Thirty men underwent TESE; 16/22 (73%) AZ patients had sperm found (mean vial number cryopreserved = 4); 8/8 (100%) men with near-AZ had sperm found (mean vial number 11). Mean FSH for these two TESE groups = 9 and 6 respectively (p=0.08). No predictors of sperm return or sperm retrieval on TESE were identified. CONCLUSIONS More than one third of men with pre-O AZ had sperm return to their semen after O. Sperm concentration was sufficient to avoid TESE in almost 20% of men. Overall, more than 80% of patients with testicular cancer and azoospermia prior to any intervention had sperm available for banking prior to adjuvant treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e939 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Teloken New York, NY More articles by this author Darren Katz New York, NY More articles by this author Boback Berookhim New York, NY More articles by this author John Mulhall New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sperm retrieval for azoospermia and intracytoplasmic sperm injection success rates – A personal overview

It is often questioned whether sperm parameters, including whether retrieved or ejaculated, have any effect on intracytoplasmic sperm injection (ICSI) results. Do severe spermatogenic defects affect embryo quality or pregnancy rate? Further, does it matter in azoospermic patients whether the sperm source is testicular or epididymal? Our studies show there is no significant difference in results with ICSI related to any sperm count parameters either with patient's sperm or even with donor sperm. No matter how poor the sperm count, there was no difference from patients with high sperm counts nor even patients using donor sperm. There is no significant difference between results with epididymal sperm, either fresh or frozen, in comparison to results with ejaculated or donor sperm. However, both pregnancy rate and delivery rate were considerably lower with testicular sperm (testis sperm extraction) than with epididymal sperm (microsurgical epididymal sperm aspiration). This was true for overall results as well as in each category of the female partner's age. It is obvious that in all these cycles the female partner's age was the most important determinant of delivery rate, but testicular sperm always yielded lower results than epididymal sperm. These results show that it is the origin of the sperm rather than the spermatogenic defect that determines success rate with ICSI.

The Utility of Optical Loupe Magnification for Testis Sperm Extraction in Men With Nonobstructive Azoospermia

The testis of patients with nonobstructive azoospermia (NOA) harbors sperm in approximately 30% to 60% of cases. Use of an operating microscope has been shown to result in better sperm retrieval rates. This investigation was undertaken to evaluate the ability of a modified microsurgical approach using magnifying loupes (3.5x) to improve the rates of sperm retrieval during testis sperm extraction (TESE). The study group consisted of patients with NOA who underwent TESE. Before December 1998, TESE was conducted in a standard fashion, and from 1999 on, loupe magnification was used. Comparison was made between the 2 groups with regard to sperm retrieval rates, need for bilateral TESE, and number of tunical incisions. Overall sperm retrieval rates did not differ between the 2 groups (45% vs 50%). However, in patients with testicular volumes of 10 mL or less, patients who underwent standard TESE had a retrieval rate of 27% compared with 42% when using the optical loupe magnification (P = .025). The use of loupe magnification may permit surgeons without access to or experience using an operating microscope to obtain better rates of sperm retrieval in men with NOA who have testicular volumes of 10 mL or less.

Microdissection testis sperm extraction does not increase sperm retrieval rates but does yield improved sperm concentration

Introduction and Objectives: Testicular sperm extraction (TESE) followed by ICSI is an effective treatment in men with non-obstructive azoospermia. Several reports have advocated microdissection to increase the rate of sperm retrieval in such men.

Postchemotherapy ejaculatory azoospermia: fatherhood with sperm from testis tissue with intracytoplasmic sperm injection.

To define the success of testis sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) in azoospermic men with a history of chemotherapy. In a retrospective study, 23 men with ejaculatory azoospermia and a history of chemotherapy underwent TESE in a search for usable spermatozoa. In six patients cryopreserved tissue and in nine patients fresh tissue provided sperm for an ICSI cycle. Histologic analysis of the testis was performed in all patients. The presence or absence of sperm, fertilization rates with ICSI, and final outcomes of pregnancy were recorded. Spermatozoa were found on TESE in 15 (65.2%) of 23 men. On histopathology, the predominant pattern observed was Sertoli cell only (47.8%), followed by hypospermatogenesis (30.4%), mixed (17.4%), and late maturation arrest (4.3%). The fertilization rate was 65.2%, and ongoing/delivered pregnancies occurred in 30.8% of cycles. Six healthy boys and four healthy girls have been born to date. Men who are azoospermic and have had prior cytotoxic therapy make up a small subgroup of males with nonobstructive azoospermia. It is important to define and characterize this subgroup and better define their true fertility potential. Approximately two thirds of these men have retrievable testis sperm, which may be used with ICSI to have healthy offspring. This exciting avenue for paternity has heretofore not been available to such patients.

Testicular tissue extraction in a young male with 47,XXY klinefelter’s syndrome: potential strategy for preservation of fertility

Objective: To describe a case involving the cryopreservation of testis tissue retrieved from a 15-year-old male teenager with Klinefelter’s syndrome. Design: Case report. Setting: An academic medical center. Patient(s): A 15-year-old boy with Klinefelter’s syndrome. Intervention(s): Microsurgical testis sperm extraction with cryopreservation of harvested tissue. Main Outcome Measure(s): Spermatozoa within testis tissue. Result(s): Successful extraction and cryopreservation of three vials of sperm-containing testis tissue. No effect on subsequent testosterone levels. Conclusion(s): Testis tissue extraction in the adequately virilized but azoospermic young male with 47, XXY Klinefelter’s syndrome may be a strategy to preserve future biological paternity.

Testicular microdissection for non-obstructive azoospermia: histopathology, sperm retrieval rates and complications comparing transverse and longitudinal sperm mapping techniques.

Objective: To determine the value of sampling the testis in a longitudinal vs. transverse surgical approach for the purpose of evaluation of histology, sperm retrieval and complication rates.Design: Prospective, controlled study in a tertiary care male reproduction practice.Materials/Methods: Patients with non obstructive azoospermia are potential candidates for testis sperm extraction (TESE) and ICSI. Several studies suggest a higher success rate in sperm retrieval using the microdissection technique. However, using the techniques described, only a small “mid” portion of the testis is examined and the other upper and lower pole “lobules” are not usually examined. We hypothesized that evaluation of upper and lower areas of the testis using a longitudinal approach might be valuable. Patients underwent combined TESE and testis biopsy for non obstructive azoospermia. All patients had no clinical or pathologic evidence of obstruction. Open TESE was performed bilaterally either under local anesthesia alone or with IV sedation. No patient had a history of unilateral injury or insults that might affect results. Patients served as their own controls as one testis underwent a “transverse” TESE and the other a “longitudinal” TESE. The same surgeon performed all TESE operations.Results: All patients had equal sized testes. Clinical diagnoses included Klinefelter’s syndrome and idiopathic. Histology, sperm retrieval and complications were recorded on all patients. The histologic pattern was Sertoli cell only (80%) and hypospermatogenesis/mostly Sertoli cell (20%). Overall, 10 biopsies were performed. Sperm were retrieved from 20% of the patients. The sperm retrieval rate was 0% in “transverse” TESE and 20% in “longitudinal” TESE. Histological diagnosis was the same in both transverse and longitudinal TESE in all patients. No complications were seen in the transverse group, but one scrotal hematocele occurred in the longitudinal group that resolved spontaneously.Conclusions: Preliminary data suggest that transverse and longitudinal incisional TESE can be performed safely. There were slight differences in sperm retrieval rates despite similar histologic patterns using these varying surgical techniques. Larger number of patients are required to determine if this technique has value for increasing sperm retrieval rates in non obstructive azoospermia. Objective: To determine the value of sampling the testis in a longitudinal vs. transverse surgical approach for the purpose of evaluation of histology, sperm retrieval and complication rates. Design: Prospective, controlled study in a tertiary care male reproduction practice. Materials/Methods: Patients with non obstructive azoospermia are potential candidates for testis sperm extraction (TESE) and ICSI. Several studies suggest a higher success rate in sperm retrieval using the microdissection technique. However, using the techniques described, only a small “mid” portion of the testis is examined and the other upper and lower pole “lobules” are not usually examined. We hypothesized that evaluation of upper and lower areas of the testis using a longitudinal approach might be valuable. Patients underwent combined TESE and testis biopsy for non obstructive azoospermia. All patients had no clinical or pathologic evidence of obstruction. Open TESE was performed bilaterally either under local anesthesia alone or with IV sedation. No patient had a history of unilateral injury or insults that might affect results. Patients served as their own controls as one testis underwent a “transverse” TESE and the other a “longitudinal” TESE. The same surgeon performed all TESE operations. Results: All patients had equal sized testes. Clinical diagnoses included Klinefelter’s syndrome and idiopathic. Histology, sperm retrieval and complications were recorded on all patients. The histologic pattern was Sertoli cell only (80%) and hypospermatogenesis/mostly Sertoli cell (20%). Overall, 10 biopsies were performed. Sperm were retrieved from 20% of the patients. The sperm retrieval rate was 0% in “transverse” TESE and 20% in “longitudinal” TESE. Histological diagnosis was the same in both transverse and longitudinal TESE in all patients. No complications were seen in the transverse group, but one scrotal hematocele occurred in the longitudinal group that resolved spontaneously. Conclusions: Preliminary data suggest that transverse and longitudinal incisional TESE can be performed safely. There were slight differences in sperm retrieval rates despite similar histologic patterns using these varying surgical techniques. Larger number of patients are required to determine if this technique has value for increasing sperm retrieval rates in non obstructive azoospermia.

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.

Testis Sperm Extraction (TESE) Is Effective in the Azoospermic Male with a History of Prior Chemotherapy

Objectives: Approximately 50% of the total group of men with non-obstructive azoospermia (NOA) will have sperm found within the testis parenchyma which can be used with ICSI to achieve biological paternity. Questions: what are the rates of sperm retrieval and pregnancy for subgroups with NOA, e.g., post-chemotherapy? The purpose of this study is to define the success of TESE and the pregnancy rates for only those men who are azoospermic due to chemotherapy so as to be able to counsel this type of NOA patient as best possible. Materials and Methods: 7 NOA men subsequent to chemotherapy and who underwent TESE comprise the study group. Harvested tissue was analyzed and cryopreserved if sperm were present and thawed homogenate used for subsequent cycles of ICSI. Age range: 28 to 43 years. legendAge at chemolegendC: cyclophosphamide; V: vincristine; D: doxorubicin; Chl: chlorambucil; Pro: procarbazine; P: prednisone; B: bleomycin; Cis: cisplatin.Reason for chemoChemo agents usedSperm present12Systemic LupusChlNo21Testis CancerCis, V, BNo4Nephrotic SyndromeC, P. ChlNo23Histiocytic lymphomaMechlorethamine, V, Pro, PYesPending24Hodgkin'sV, C, DYes7Twins lost at 25 weeks15Ewing's SarcomaV, D, Actinomycin DYes1Ongoing pregnancy15Testis CancerCis, Vp-16, BYes1Ongoing pregnancylegend C: cyclophosphamide; V: vincristine; D: doxorubicin; Chl: chlorambucil; Pro: procarbazine; P: prednisone; B: bleomycin; Cis: cisplatin. Open table in a new tab Results: Of the 7 men, 4 (57%) had sperm found during TESE. These 4 men were all pubertal or post-pubertal at the time of chemotherapy. The fertilization rate ranged from 58–80%. The twin aborteses were normal in appearance, premature rupture of membranes the cause. Conclusion: For the subgroup of men with NOA due to prior chemotherapy, TESE may be successful and pregnancy can be achieved. These are early and encouraging results but since there are so many types of chemotherapy agents used, large numbers of patients will be needed to give an individual patient an accurate assessment of his chances. In addition, the children will need to be followed carefully as there is no data as to their future health. Data that discusses naturally conceived offspring of post-chemotherapy men cannot be applied to this group as spermatogenesis in these men returned to good levels, unlike this study group who were more severely and permanently affected.

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.

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.