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-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T16:05:08.940Z Has data issue: false hasContentIssue false

Chapter 8 - Sperm Retrieval in Non-azoospermic Men

Indications, Protocol, and Outcomes

from Part II - Sperm Retrieval

Published online by Cambridge University Press:  09 April 2021

By
Sandro C. Esteves  and
Ahmad Majzoub
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

Sperm retrieval and intracytoplasmic sperm injection (ICSI) has become the natural treatment for couples with azoospermia-related infertility, and nowadays is also used for nonazoospermic indications. An increasing body of evidence overwhelmingly based on cohort studies has indicated that ICSI with ejaculated sperm of poor quality negatively affects the chances of assisted conception. Collectively, these data suggest that ICSI with testicular sperm is superior to ICSI with ejaculated sperm as a method of fertilization to overcome sperm DNA fragmentation-related infertility. The candidates are men with high sperm DNA damage in semen and those with severe oligozoospermia or cryptozoospermia. In these patients, percutaneous and open sperm retrieval are highly successful to harvest sperm, with few complications. Current evidence suggests the safe utilization of testicular sperm for ICSI in nonazoospermic men. Further research is warranted to confirm the clinical utility of this approach as a routine ART treatment.

Keywords

sperm DNA fragmentationsperm chromatin damagesperm retrievaltesticular spermejaculated spermassisted reproductive technologyin vitro fertilizationintracytoplasmic sperm injectionoligozoospermiacryptozoospermiapregnancyoffspring healthmale infertility
Type
Chapter
Information
Manual of Sperm Retrieval and Preparation in Human Assisted Reproduction , pp. 56 - 74
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

Palermo, GD, Neri, QV, Rosenwaks, Z. To ICSI or not to ICSI. Semin Reprod Med 2015;33:92–102.Google Scholar
Palermo, G, Joris, H, Devroey, P, Van Steirteghem, AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340:17–18.Google Scholar
Esteves, SC, Roque, M, Bedoschi, G, Haahr, T, Humaidan, P. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 2018;15:535–562.Google Scholar
Esteves, SC, Miyaoka, R, Orosz, JE, Agarwal, A. An update on sperm retrieval techniques for azoospermic males. Clinics (Sao Paulo) 2013;68(Suppl. 1):99–110.CrossRefGoogle ScholarPubMed
Esteves, SC. Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 2016;33:1319–1335.CrossRefGoogle ScholarPubMed
Esteves, SC, Miyaoka, R, Agarwal, A. Surgical treatment of male infertility in the era of intracytoplasmic sperm injection: new insights. Clinics (Sao Paulo) 2011;66:1463–1478.Google Scholar
Esteves, SC. Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl 2015;17: 459–470.Google Scholar
Miyaoka, R, Esteves, SC. Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role?. Clinics (Sao Paulo) 2013;68(Suppl. 1):111–119.CrossRefGoogle ScholarPubMed
Esteves, SC, Lee, W, Benjamin, DJ, et al. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol 2013;189:232–237.Google Scholar
Nagy, ZP, Liu, J, Joris, H, et al. The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum Reprod 1995;10:1123–1129.Google Scholar
Strassburger, D, Friedler, S, Raziel, A, et al. Very low sperm count affects the result of intracytoplasmic sperm injection. J Assist Reprod Genet 2000;17:431–436.CrossRefGoogle ScholarPubMed
Mitchell, V, Rives, N, Albert, M, et al. Outcome of ICSI with ejaculated spermatozoa in a series of men with distinct ultrastructural flagellar abnormalities. Hum Reprod 2006;21:2065–2074.CrossRefGoogle Scholar
Verza, S Jr, Esteves, SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol 2008;34:49–56.Google Scholar
Krawetz, SA. Paternal contribution: new insights and future challenges. Nat Rev Genet 2005;6:633–642.Google Scholar
Agarwal, A, Majzoub, A, Esteves, SC, et al. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2016;5:935–950.CrossRefGoogle ScholarPubMed
Rima, D, Shiv, BK, Bhavna, Ch, Shilpa, B, Saima, Kh. Oxidative stress induced damage to paternal genome and impact of meditation and yoga: can it reduce incidence of childhood cancer? Asian Pac J Cancer Prev 2016;17:4517–4525.Google Scholar
Aitken, RJ. DNA damage in human spermatozoa: important contributor to mutagenesis in the offspring. Transl Androl Urol 2017;6(4):761–764.CrossRefGoogle ScholarPubMed
McPherson, S, Longo, FJ. Chromatin structure–function alterations during mammalian spermatogenesis: DNA nicking and repair in elongating spermatids. Eur J Histochem 1995;37:109–128.Google Scholar
Sotolongo, B, Huang, TT, Isenberger, E, Ward, WS. An endogenous nuclease in hamster, mouse, and human spermatozoa cleaves DNA into loop-sized fragments. J Androl 2005;26:272–280.CrossRefGoogle ScholarPubMed
Sakkas, D, Alvarez, JG. Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis. Fertil Steril 2010;93:1027–1036.Google Scholar
Muratori, M, Tamburrino, L, Marchiani, S, et al. Investigation on the origin of sperm DNA fragmentation: role of apoptosis, immaturity and oxidative stress. Mol Med 2015;21:109–122.CrossRefGoogle ScholarPubMed
Gosálvez, J, Lopez-Fernandez, C, Fernandez, JL, Esteves, SC, Johnston, SD. Unpacking the mysteries of sperm DNA fragmentation: ten frequently asked questions. J Reprod Biotechnol Fertil 2015;4:1–16.Google Scholar
Santi, D, Spaggiari, G, Simoni, M. Sperm DNA fragmentation index as a promising predictive tool for male infertility diagnosis and treatment management: meta-analyses. Reprod Biomed Online 2018;37(3):315–326.CrossRefGoogle ScholarPubMed
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(1):87–95.Google Scholar
Moskovtsev, SI, Willis, J, White, J, Mullen, JB. Sperm DNA damage: correlation to severity of semen abnormalities. Urology 2009;74:789–793.Google Scholar
Belloc, S, Benkhalifa, M, Cohen-Bacrie, M, et al. Sperm deoxyribonucleic acid damage in normozoospermic men is related to age and sperm progressive motility. Fertil Steril 2014;101:1588–1593.CrossRefGoogle ScholarPubMed
Esteves, SC. Interventions to prevent sperm DNA damage effects on reproduction. Adv Exp Med Biol 2019;1166:119–148.CrossRefGoogle ScholarPubMed
Steele, EK, McClure, N, Maxwell, RJ, Lewis, SE. A comparison of DNA damage in testicular and proximal epididymal spermatozoa in obstructive azoospermia. Mol Hum Reprod 1999;5:831–835.Google Scholar
O’Connell, M, McClure, N, Lewis, SE. Mitochondrial DNA deletions and nuclear DNA fragmentation in testicular and epididymal human sperm. Hum Reprod 2002;17:1565–1570.CrossRefGoogle ScholarPubMed
Hammoud, I, Bailly, M, Bergere, M, et al. Testicular spermatozoa are of better quality than epididymal spermatozoa in patients with obstructive azoospermia. Urology 2017;103:106–111.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
Moskovtsev, SI, Alladin, N, Lo, KC, et al. A comparison of ejaculated and testicular spermatozoa aneuploidy rates in patients with high sperm DNA damage. Syst Biol Reprod Med 2012;58:142–148.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
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.CrossRefGoogle ScholarPubMed
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
Bradley, CK, McArthur, SJ, Gee, AJ, et al. Intervention improves assisted conception intracytoplasmic sperm injection outcomes for patients with high levels of sperm DNA fragmentation: a retrospective analysis. Andrology 2016;4:903–910.CrossRefGoogle ScholarPubMed
Pabuccu, EG, Caglar, GS, Tangal, S, Haliloglu, AH, Pabuccu, R. Testicular versus ejaculated spermatozoa in ICSI cycles of normozoospermic men with high sperm DNA fragmentation and previous ART failures. Andrologia 2017;49(2).doi: 10.1111/and.12609.Google Scholar
Zhang, J, Xue, H, Qiu, F, Zhong, J, Su, J. Testicular spermatozoon is superior to ejaculated spermatozoon for intracytoplasmic sperm injection to achieve pregnancy in infertile males with high sperm DNA damage. Andrologia 2018;51:e13175.Google Scholar
Herrero, MB, Lusignan, MF, Son, WY, et al. ICSI outcomes using testicular spermatozoa in non-azoospermic couples with recurrent ICSI failure and no previous live births. Andrology 2019;7:281–287.Google Scholar
Arafa, M, AlMalki, A, AlBadr, M, et al. ICSI outcome in patients with high DNA fragmentation: testicular versus ejaculated spermatozoa. Andrologia 2018;50(1). doi: 10.1111/and.12835.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.CrossRefGoogle ScholarPubMed
Cui, X, Ding, P, Gao, G, Zhang, Y. Comparison of the clinical outcomes of intracytoplasmic sperm injection between spermatozoa retrieved from testicular biopsy and from ejaculate in cryptozoospermia patients. Urology 2017;102:106–110.CrossRefGoogle ScholarPubMed
Yu, Y, Wang, R, Xi, Q, et al. Effect of paternal age on intracytoplasmic sperm injection outcomes in cryptozoospermic men: ejaculated or testicular sperm? Medicine (Baltimore) 2019;98(26):e16209.Google Scholar
Abhyankar, N, Kathrins, M, Niederberger, C. Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia: a meta-analysis. Fertil Steril 2016;105:1469–1475.CrossRefGoogle ScholarPubMed
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
Bendikson, KA, Neri, QV, Takeuchi, T, et al. The outcome of intracytoplasmic sperm injection using occasional spermatozoa in the ejaculate of men with spermatogenic failure. J Urol 2008;180:1060–1064.Google Scholar
Hauser, R, Bibi, G, Yogev, L, et al. Virtual azoospermia and cryptozoospermia: fresh/frozen testicular or ejaculate sperm for better IVF outcome?. J Androl 2011;32:484–490.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
Weissman, A, Horowitz, E, Ravhon, A, et al. Pregnancies and live births following ICSI with testicular spermatozoa after repeated implantation failure using ejaculated spermatozoa. Reprod Biomed Online 2008;17:605–609.CrossRefGoogle ScholarPubMed
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
Schlegel, PN, Li, PS. Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Hum Reprod Update 1998;4:439.CrossRefGoogle ScholarPubMed
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, Varghese, AC. Laboratory handling of epididymal and testicular spermatozoa: what can be done to improve sperm injections outcome. J Hum Reprod Sci 2012;5:233–243.Google Scholar
Esteves, SC, Bento, FC. Implementation of air quality control in reproductive laboratories in full compliance with the Brazilian Cells and Germinative Tissue Directive. Reprod Biomed Online 2013;26:9–21.CrossRefGoogle ScholarPubMed
Esteves, SC, Verza Jr, S. PESA/TESA/TESE sperm processing. In: Nagy, Z, Varghese, A, Agarwal, A (eds.) Practical Manual of In Vitro Fertilization, 2nd edn. Springer, New York, 2019, pp. 202–220.Google Scholar
Nabi, A, Khalili, MA, Halvaei, I, Roodbari, F. Prolonged incubation of processed human spermatozoa will increase DNA fragmentation. Andrologia 2014;46:374–379.Google Scholar
Paoli, D, Pelloni, M, Lenzi, A, Lombardo, F. Cryopreservation of sperm: effects on chromatin and strategies to prevent them. Adv Exp Med Biol 2019;1166:149–167.Google Scholar
Lopes, LS, Esteves, SC. Testicular sperm for intracytoplasmic sperm injection in non-azoospermic men: a paradigm shift. Panminerva Med 2019;61:178–186.CrossRefGoogle ScholarPubMed
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
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
Esteves, SC. Should a couple with failed in vitro fertilization or intracytoplasmic sperm injection and elevated sperm DNA fragmentation use testicular sperm for the next cycle? Eur Urol Focus 2018;4:296–298.Google Scholar
Amirjannati, N, Heidari-Vala, H, Akhondi, MA, et al. Comparison of intracytoplasmic sperm injection outcomes between spermatozoa retrieved from testicular biopsy and from ejaculation in cryptozoospermic men. Andrologia 2012;44(Suppl. 1):704–709.Google Scholar
Ku, FY, Wu, CC, Hsiao, YW, Kang, YN. Association of sperm source with miscarriage and take-home baby after ICSI in cryptozoospermia: a meta-analysis of testicular and ejaculated sperm. Andrology 2018;6:882–889.Google Scholar
Bonduelle, M, Van Assche, E, Joris, H, et al. Prenatal testing in ICSI pregnancies: incidence of chromosomal anomalies in 1586 karyotypes and relation to sperm parameters. Hum Reprod 2002;17:2600–2614.Google Scholar
Belva, F, De Schrijver, F, Tournaye, H, et al. Neonatal outcome of 724 children born after ICSI using non-ejaculated sperm. Hum Reprod 2011;26:1752–1758.Google Scholar
Tsai, CC, Huang, FJ, Wang, LJ, et al. Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study. Fertil Steril 2011;96:561–571.Google Scholar
Esteves, SC, Agarwal, A. Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review. Clinics 2013;68(1):141–150.CrossRefGoogle ScholarPubMed
Meijerink, AM, Ramos, L, Janssen, AJ, et al. Behavioral, cognitive, and motor performance and physical development of five-year-old children who were born after intracytoplasmic sperm injection with the use of testicular sperm. Fertil Steril 2016;106:1673–1682.CrossRefGoogle ScholarPubMed
Levron, J, Aviram-Goldring, A, Madgar, I, et al. Sperm chromosome abnormalities in men with severe male factor infertility who are undergoing in vitro fertilization with intracytoplasmic sperm injection. Fertil Steril 2001;76:479–484.Google Scholar
Palermo, GD, Colombero, LT, Hariprashad, JJ, Schlegel, PN, Rosenwaks, Z. Chromosome analysis of epididymal and testicular sperm in azoospermic patients undergoing ICSI. Hum Reprod 2002;17:570–575.CrossRefGoogle ScholarPubMed
Rodrigo, L, Rubio, C, Peinado, V, et al. Testicular sperm from patients with obstructive and nonobstructive azoospermia: aneuploidy risk and reproductive prognosis using testicular sperm from fertile donors as control samples. Fertil Steril 2011;95:1005–1012.Google Scholar
Vozdova, M, Heracek, J, Sobotka, V, Rubes, J. Testicular sperm aneuploidy in non-obstructive azoospermic patients. Hum Reprod 2012;27:2233–2239.Google Scholar
Cheung, S, Schlegel, PN, Rosenwaks, Z, Palermo, GD. Revisiting aneuploidy profile of surgically retrieved spermatozoa by whole exome sequencing molecular karyotype. PLoS ONE 2019;14:e0210079.Google Scholar
Suganuma, R, Yanagimachi, R, Meistrich, ML. Decline in fertility of mouse sperm with abnormal chromatin during epididymal passage as revealed by ICSI. Hum Reprod 2005;20:3101–3108.Google Scholar
Weng, SP, Surrey, MW, Danzer, HC, et al. Chromosome abnormalities in embryos derived from microsurgical epididymal sperm aspiration and testicular sperm extraction. Taiwan J Obstet Gynecol 2014;53:202–205.CrossRefGoogle ScholarPubMed
Figueira, R, Carvalho, JF, Bento, FC, et al.ICSI using surgically retrieved testicular sperm of non-azoospermic men with high sperm DNA fragmentation index and blastocyst ploidy: a safe approach. Abstracts of the 35th Annual Meeting of the European Society of Human Reproduction and Embryology. Hum Reprod 2019;34(1):i1–i543.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
×