Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-16T08:32:29.619Z Has data issue: false hasContentIssue false

Chapter 23 - Sperm Retrieval Surgery

from Section 4 - Treatment of Male Infertility

Published online by Cambridge University Press:  08 July 2023

By
Peter N. Schlegel
Edited by
Larry I. Lipshultz ,
Stuart S. Howards ,
Craig S. Niederberger  and
Dolores J. Lamb
Larry I. Lipshultz
Affiliation:
Baylor College of Medicine, Texas
Stuart S. Howards
Affiliation:
University of Virginia
Craig S. Niederberger
Affiliation:
University of Illinois, Chicago
Dolores J. Lamb
Affiliation:
Weill Cornell Medical College, New York
Get access

Summary

Sperm retrieval is most commonly performed for azoospermic men. Azoospermia may be the result of severely impaired sperm production (azoospermia due to spermatogenic dysfunction) or normal sperm production in the setting of physical blockage of sperm transport (obstructive azoospermia). Although microsurgical reconstruction is possible for many men with obstructive azoospermia, some couples will still elect sperm retrieval with use of assisted reproductive technology (ART), including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART allows men who have surgically retrieved sperm to contribute to pregnancies, even when limited numbers of viable sperm are available and even if sperm have not matured by proceeding through the entire male reproductive system. The management of men with obstructive azoospermia and of those with azoospermia due to spermatogenic dysfunction is markedly different. Not only does the genetic/diagnostic testing vary for these two conditions, but also the management and outcomes take different directions.

Type
Chapter
Information
Infertility in the Male , pp. 437 - 445
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schoor, RA, Elhanbly, S, Niederberger, CS, Ross, LS. The role of testicular biopsy in the modern management of male infertility. J Urol 2002;167:197–200.Google Scholar
Jarvi, K, Lo, K, Fischer, A, et al. CUA Guideline: The workup of azoospermic males. Can Urol Assoc J 2010;4:163–7.CrossRefGoogle ScholarPubMed
Bernie, AM, Mata, DA, Ramasamy, R, Schlegel, PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril 2015;104:1099–103.CrossRefGoogle ScholarPubMed
Schlegel, PN, Su, L-M, Li, PS. Pathophysiologic changes after testicular sperm extraction: patterns and avoidance of testicular injury. In: Hamamah, S, Olivennes, F, Mieusset, R, Frydman, R, eds. Male Sterility and Motility Disorders: Etiologic Factors and Treatment. New York, NY: Springer-Verlag, 1999; pp. 243–52.Google Scholar
Khadra, A.A., Abdulhadi, I., Ghunain, S., Kilani, Z. Efficiency of percutaneous testicular sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia. J Urol. 2003;169:603–605.CrossRefGoogle Scholar
Gottschalk-Sabag, S., Glick, T., Bar-On, E., Weiss, D.B. Testicular fine needle aspiration as a diagnostic method. Fertil Steril. 1993;59:1129–1131.CrossRefGoogle Scholar
Meng, MV, Cha, I, Ljung, BM, Turek, PJ. Relationship between classic histological pattern and sperm findings on fine needle aspiration map in infertile men. Hum Reprod 2000;15:1973–7.CrossRefGoogle ScholarPubMed
Ron-El, R, Strassburger, D, Friedler, S, et al. Extended sperm preparation: an alternative to testicular sperm extraction in non-obstructive azoospermia. Hum Reprod 1997;12:1222–6.Google Scholar
Fahmy, I, Mansour, R, Aboulghar, M, et al. Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non-obstructive azoospermia. Int J Androl 1997;20:37–44.CrossRefGoogle ScholarPubMed
Amer, M, Haggar, SE, Moustafa, T, Abd El-Naser, T, Zohdy, W. Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Hum Reprod 1999;14:3030–4.Google Scholar
Schlegel, PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14:131–5.CrossRefGoogle ScholarPubMed
Okada, H, Dobashi, M, Yamazaki, T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002;168:1063–7.Google Scholar
Tsujimura, A, Matsumiya, K, Miyagawa, Y, et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 2002;17:2924–9.Google Scholar
Ramasamy, R, Yagan, N, Schlegel, PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65:1190–4.Google Scholar
Ramasamy, R, Schlegel, PN. Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval. J Urol 2007;177:1447–9.CrossRefGoogle ScholarPubMed
Schlegel, PN, Su, LM. Physiological consequences of testicular sperm extraction. Hum Reprod 1997;12:1688–92.CrossRefGoogle ScholarPubMed
Amer, M, Ateyah, A, Hany, R, Zohdy, W. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Hum Reprod 2000;15:653–6.Google Scholar
Everaert, K, De Croo, I, Kerckhaert, W, et al. Long term effects of micro-surgical testicular sperm extraction on androgen status in patients with non obstructive azoospermia. BMC Urol 2006;6:9.CrossRefGoogle ScholarPubMed
Schlegel, PN, Liotta, D, Hariprashad, J, Veeck, LL. Fresh testicular sperm from men with non-obstructive azoospermia works best for ICSI. Urology 2004;64:1069–71.CrossRefGoogle Scholar
Ohlander, S, Hotaling, J, Kirshenbaum, E, Niederberger, C, Eisenberg, ML. Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis. Fertil Steril 2014;101:344–9.Google Scholar
Fullerton, G, Hamilton, M, Maheshwari, A. Should non-mosaic Klinefelter syndrome men be labelled as infertile in 2009? Hum Reprod 2010;25:588–97.Google Scholar
Dabaja, AA, Schlegel, PN. Microdissection testicular sperm extraction: an update. Asian J Androl 2013;15:35–9.CrossRefGoogle ScholarPubMed
Damani, MN, Master, V, Meng, MV, Burgess, C, Turek, P, Oates, RD. Postchemotherapy ejaculatory azoospermia: fatherhood with sperm from testis tissue with intracytoplasmic sperm injection. J Clin Oncol 2002;20:930–6.CrossRefGoogle ScholarPubMed
Hopps, CV, Mielnik, A, Goldstein, M, Palermo, GD, Rosenwaks, Z, Schlegel, PN. Detection of sperm in men with Y chromosome microdeletions of the AZFa, AZFb and AZFc regions. Hum Reprod 2003;18:1660–5.CrossRefGoogle ScholarPubMed
Oates, RD. Clinical evaluation of the infertile male with respect to genetic etiologies. Syst Biol Reprod Med 2011;57:72–7.CrossRefGoogle ScholarPubMed
Choi, DY, Gong, IH, Hwang, JH, Oh, JJ, Jong, JY. Detection of Y chromosome microdeletion is valuable in the treatment of patients with nonobstructive azoospermia and oligoasthenoteratozoospermia: sperm retrieval rate and birth rate. Korean J Urol 2013;54:111–16.CrossRefGoogle ScholarPubMed
Weedin, JW, Bennett, RC, Fenig, DM, Lamb, DJ, Lipshultz, LI. Early versus late maturation arrest: reproductive outcomes of testicular failure. J Urol 2011;186:621–6.CrossRefGoogle ScholarPubMed
Sheynkin, YR, Ye, Z, Menendez, S, Liotta, D, Veeck, LL, Schlegel, PN. Controlled comparison of percutaneous and microsurgical sperm retrieval in men with obstructive azoospermia. Hum Reprod 1998;13:3086–9.Google Scholar
Lee, R, Li, PS, Goldstein, M, Tanrikut, C, Schattman, G, Schlegel, PN. A decision analysis of treatments for obstructive azoospermia. Hum Reprod 2008;23:2043–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×