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-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-01T00:48:40.812Z Has data issue: false hasContentIssue false

Chapter 6 - Testicular Sperm Retrieval

Indications, Surgical Protocol, and Outcomes

from Part II - Sperm Retrieval

Published online by Cambridge University Press:  09 April 2021

By
Ahmad Majzoub ,
Chak Lam Cho  and
Sandro C. Esteves
Edited by
Ashok Agarwal ,
Ahmad Majzoub  and
Sandro C. Esteves
Ashok Agarwal
Affiliation:
The Cleveland Clinic Foundation, Cleveland, OH, USA
Ahmad Majzoub
Affiliation:
Hamad Medical Corporation, Doha, Qatar
Sandro C. Esteves
Affiliation:
Andrology & Human Reproduction Clinic, Sao Paulo, Brazil
Get access

Summary

The development of surgical sperm retrieval procedures can be considered as the single most important breakthrough in the field of male infertility. Various testicular sperm retrieval procedures exist and are indicated in patients with obstructive and nonobstructive azoospermia, as well as patients with high levels of sperm DNA fragmentation and severe derangements in semen parameters. Microsurgical testicular sperm extraction can be considered the gold standard retrieval method as it allows meticulous and selective sampling of sperm-containing seminiferous tubules, yielding the highest retrieval rate in comparison to other surgical sperm retrieval methods.

Keywords

surgical sperm retrievalsperm DNA fragmentationnonobstructive azoospermiamicro-testicular sperm extraction
Type
Chapter
Information
Manual of Sperm Retrieval and Preparation in Human Assisted Reproduction , pp. 36 - 43
Publisher: Cambridge University Press
Print publication year: 2021

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

Cocuzza, M, Alvarenga, C, Pagani, R. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo) 2013;68(Suppl. 1):15–26.Google Scholar
Devroey, P, Liu, J, Nagy, Z, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 1995;10:1457–1460.CrossRefGoogle ScholarPubMed
Craft, I, Tsirigotis, M. Simplified recovery, preparation and cryopreservation of testicular spermatozoa. Hum Reprod 1995;10:1623–1626.CrossRefGoogle ScholarPubMed
Ron-El, R, Strauss, S, Friedler, S, et al. Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction. Hum Reprod 1998;13:3390–3393.CrossRefGoogle ScholarPubMed
Schlegel, PN, Su, LM. Physiological consequences of testicular sperm extraction. Hum Reprod 1997;12:1688–1692.CrossRefGoogle ScholarPubMed
Schlegel, PN, Li, PS. Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Hum Reprod Update 1998;4:439.Google Scholar
Shah, RS. Advanced Infertility Management. Jaypee Brothers, New Delhi, 2002.Google Scholar
Temple-Smith, PD, Southwick, GJ, Yates, CA, Trounson, AO, de Kretser, DM. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert Embryo Transf 1985;2:119–122.Google Scholar
Esteves, SC, Miyaoka, R, Agarwal, A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011;37:570–583.Google Scholar
Sakkas, D, Alvarez, JG. Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis. Fertil Steril 2010;93:1027–1036.CrossRefGoogle ScholarPubMed
Majzoub, A, Agarwal, A, Esteves, SC. Sperm DNA fragmentation: a rationale for its clinical utility. Transl Androl Urol 2017;6:S455–S456.CrossRefGoogle ScholarPubMed
Lewis, SE, John Aitken, R, Conner, SJ, et al. The impact of sperm DNA damage in assisted conception and beyond: recent advances in diagnosis and treatment. Reprod Biomed Online 2013;27:325–337.Google Scholar
Leach, M, Aitken, RJ, Sacks, G. Sperm DNA fragmentation abnormalities in men from couples with a history of recurrent miscarriage. Aust N Z J Obstet Gynaecol 2015;55:379–383.Google Scholar
Jin, J, Pan, C, Fei, Q, et al. Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ovarian reserves. Fertil Steril 2015;103:910–916.Google Scholar
Majzoub, A, Agarwal, A, Esteves, SC. Sperm DNA fragmentation for the evaluation of male infertility: clinical algorithms. Transl Androl Urol 2017;6:S405–S408.CrossRefGoogle ScholarPubMed
Agarwal, A, Cho, CL, Majzoub, A, Esteves, SC. The Society for Translational Medicine: clinical practice guidelines for sperm DNA fragmentation testing in male infertility. Transl Androl Urol 2017;6:S720–S733.Google Scholar
Wright, C, Milne, S, Leeson, H. Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reprod Biomed Online 2014;28:684–703.Google Scholar
Sakkas, D, Mariethoz, E, Manicardi, G, et al. Origin of DNA damage in ejaculated human spermatozoa. Rev Reprod 1999;4:31–37.Google Scholar
Ni, K, Steger, K, Yang, H, et al. A comprehensive investigation of sperm DNA damage and oxidative stress injury in infertile patients with subclinical, normozoospermic, and astheno/oligozoospermic clinical varicocoele. Andrology 2016;4:816–824.CrossRefGoogle ScholarPubMed
Moustafa, MH, Sharma, RK, Thornton, J, et al. Relationship between ROS production, apoptosis and DNA denaturation in spermatozoa from patients examined for infertility. Hum Reprod 2004;19:129–138.Google Scholar
Majzoub, A, Arafa, M, Mahdi, M, et al. Oxidation-reduction potential and sperm DNA fragmentation, and their associations with sperm morphological anomalies amongst fertile and infertile men. Arab J Urol 2018;16:87–95.Google Scholar
Greco, E, Scarselli, F, Iacobelli, M, et al. Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa. Hum Reprod 2005;20:226–230.Google Scholar
Moskovtsev, SI, Jarvi, K, Mullen, JB, et al. Testicular spermatozoa have statistically significantly lower DNA damage compared with ejaculated spermatozoa in patients with unsuccessful oral antioxidant treatment. Fertil Steril 2010;93:1142–1146.Google Scholar
Esteves, SC, Sanchez-Martin, F, Sanchez-Martin, P, Schneider, DT, Gosalvez, J. Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm. Fertil Steril 2015;104:1398–1405.Google Scholar
Esteves, SC, Roque, M, Bradley, CK, Garrido, N. Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis. Fertil Steril 2017;108:456–467.Google Scholar
Mehta, A, Bolyakov, A, Schlegel, PN, Paduch, DA. Higher pregnancy rates using testicular sperm in men with severe oligospermia. Fertil Steril 2015;104:1382–1387.Google Scholar
Esteves, SC, Roque, M, Garrido, N. Use of testicular sperm for intracytoplasmic sperm injection in men with high sperm DNA fragmentation: a SWOT analysis. Asian J Androl 2018;20:1–8.Google Scholar
Ketabchi, AA. Intracytoplasmic sperm injection outcomes with freshly ejaculated sperms and testicular or epididymal sperm extraction in patients with idiopathic cryptozoospermia. Nephrourol Mon 2016;8:e41375.Google Scholar
Ben-Ami, I, Raziel, A, Strassburger, D, et al. Intracytoplasmic sperm injection outcome of ejaculated versus extracted testicular spermatozoa in cryptozoospermic men. Fertil Steril 2013;99:1867–1871.Google Scholar
Kang, YN, Hsiao, YW, Chen, CY, Wu, CC. Testicular sperm is superior to ejaculated sperm for ICSI in cryptozoospermia: an update systematic review and meta-analysis. Sci Rep 2018;8:7874.Google Scholar
Morey, AF, Deshon, GE Jr., Rozanski, TA, Dresner, ML. Technique of biopty gun testis needle biopsy. Urology 1993;42:325–326.Google Scholar
Schlegel, PN. Nonobstructive azoospermia: a revolutionary surgical approach and results. Semin Reprod Med 2009;27:165–170.Google Scholar
Esteves, SC. Microdissection testicular sperm extraction (micro-TESE) as a sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects. Int Braz J Urol 2013;39:440.Google Scholar
Esteves, SC, Agarwal, A. Sperm Retrieval Techniques. Cambridge University Press, Cambridge, 2011.Google Scholar
Ramasamy, R, Yagan, N, Schlegel, PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65:1190–1194.Google Scholar
Carpi, A, Menchini Fabris, FG, Palego, P, et al. Fine-needle and large-needle percutaneous aspiration biopsy of testicles in men with nonobstructive azoospermia: safety and diagnostic performance. Fertil Steril 2005;83:1029–1033.Google Scholar
Komori, K, Tsujimura, A, Miura, H, et al. Serial follow-up study of serum testosterone and antisperm antibodies in patients with non-obstructive azoospermia after conventional or microdissection testicular sperm extraction. Int J Androl 2004;27:32–36.Google Scholar
Xu, T, Peng, L, Lin, X, Li, J, Xu, W. Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in nonobstructive azoospermia patients. Andrologia 2017;49. doi: 10.1111/and.12642.CrossRefGoogle ScholarPubMed
Cissen, M, Meijerink, AM, D’Hauwers, KW, et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2016;31:1934–1941.Google Scholar
Donoso, P, Tournaye, H, Devroey, P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007;13:539–549.Google Scholar
Carpi, A, Sabanegh, E, Mechanick, J. Controversies in the management of nonobstructive azoospermia. Fertil Steril 2009;91:963–970.Google Scholar
Ezeh, UI, Moore, HD, Cooke, ID. A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 1998;13:3075–3080.Google Scholar
Hauser, R, Yogev, L, Paz, G, et al. Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia: multifocal testicular sperm extraction versus multifocal testicular sperm aspiration. J Androl 2006;27:28–33.Google Scholar
Friedler, S, Raziel, A, Strassburger, D, et al. Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997;12:1488–1493.Google Scholar
Esteves, SC, Verza, S, Prudencio, C, Seol, B. Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia. Fertil Steril 2010;94:S132.Google Scholar
Schlegel, PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14:131–135.CrossRefGoogle ScholarPubMed
Schiff, JD, Palermo, GD, Veeck, LL, et al. Success of testicular sperm extraction [corrected] and intracytoplasmic sperm injection in men with Klinefelter syndrome. J Clin Endocrinol Metab 2005;90:6263–6367.Google Scholar
Turunc, T, Gul, U, Haydardedeoglu, B, et al. Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study. Fertil Steril 2010;94:2157–2160.CrossRefGoogle ScholarPubMed
Silber, SJ. Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod 2000;15:2278–2284.Google Scholar
Okada, H, Dobashi, M, Yamazaki, T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002;168:1063–1067.CrossRefGoogle ScholarPubMed
Tsujimura, A. Microdissection testicular sperm extraction: prediction, outcome, and complications. Int J Urol 2007;14:883–889.Google Scholar
Chan, PT, Palermo, GD, Veeck, LL, Rosenwaks, Z, Schlegel, PN. Testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of men with persistent azoospermia postchemotherapy. Cancer 2001;92:1632–1637.Google Scholar
Raman, JD, Schlegel, PN. Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism. J Urol 2003;170:1287–1290.Google Scholar
Deruyver, Y, Vanderschueren, D, Van der Aa, F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2014;2:20–24.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;104:1099–1103.Google Scholar
Altay, B, Hekimgil, M, Cikili, N, Turna, B, Soydan, S. Histopathological mapping of open testicular biopsies in patients with unobstructive azoospermia. BJU Int 2001;87:834–837.Google Scholar
Shah, RS. Surgical sperm retrieval: techniques and their indications. Indian J Urol 2011;27:102–109.Google Scholar
Tournaye, H, Liu, J, Nagy, PZ, et al. Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1996;11:127–132.Google Scholar
Mulhall, JP, Ghaly, SW, Aviv, N, Ahmed, A. The utility of optical loupe magnification for testis sperm extraction in men with nonobstructive azoospermia. J Androl 2005;26:178–181.Google Scholar
Esteves, SC, Miyaoka, R, Orosz, JE, Agarwal, A. An update on sperm retrieval techniques for azoospermic males. Clinics (Sao Paulo) 2013;68(1):99–110.CrossRefGoogle ScholarPubMed
Esteves, SC. Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl 2015;17:459–470.Google Scholar
Miyaoka, R, Orosz, JE, Achermann, AP, Esteves, SC. Methods of surgical sperm extraction and implications for assisted reproductive technology success. Panminerva Med 2019;61:164–177.Google Scholar
Esteves, SC. Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 2016;33:1319–1335.Google Scholar

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
×