Controversies in the management of nonobstructive azoospermia

Carpi, Angelo; Sabanegh, Edmund; Mechanick, Jeffrey I.

doi:10.1016/j.fertnstert.2009.01.083

Cited by 72 publications

(57 citation statements)

References 90 publications

(153 reference statements)

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“…Intratesticular hematoma has been observed in most patients undergoing TESE with single or multiple biopsies based on ultrasounds results performed after surgery, but they often resolve spontaneously without compromising testicular function (20). However, it has been reported that large-volume conventional TESE is associated with a higher risk of transient or even permanent decrease in serum testosterone levels due to testicular devascularization (19,22). The incidence of complications following micro-TESE is lower than conventional TESE (17,19,21,23).…”

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

“…Nonetheless, testosterone levels return to the pre-surgical values in most individuals in a 12-month follow-up period. It is recommended that sperm retrievals should be performed by surgeons who have training in the procedures because of the potential serious postoperative complications (22).…”

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

“…Randomized controlled trials are lacking to compare the efficiency of the available methods and current recommendations are based upon cumulative evidence provided by descriptive, observational and controlled studies (7,9,22,23,32). The advantages and limitations of sperm retrieval techniques are shown in Table-2.…”

Section: Sperm Retrieval Success Rates and Intracytoplasmic Sperm Injmentioning

confidence: 99%

“…Efficiency of sperm retrieval in NOA males varies according to the method of sperm collection. TESA retrieval rates range from 10-30% (22,23,(39)(40)(41), except in the favorable cases of previous successful TESA or testicular histopathology showing hypospermatogenesis. In such cases, TESA SRR range from 70-100% (6,10).…”

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

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Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

123

117

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Different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE have been developed to retrieve spermatozoa from either the epididymis or the testis according to the type of azoospermia, i.e., obstructive or non-obstructive. Laboratory techniques are used to remove contaminants, cellular debris, and red blood cells following collection of the epididymal fluid or testicular tissue. Surgically-retrieved spermatozoa may be used for intracytoplasmic sperm injection (ICSI) and/or cryopreservation. In this article, we review the surgical procedures for retrieving spermatozoa from both the epididymis and the testicle and provide technical details of the commonly used methods. A critical analysis of the advantages and limitations of the current surgical methods to retrieve sperm from males with obstructive and non-obstructive azoospermia is presented along with an overview of the laboratory techniques routinely used to process surgically-retrieved sperm. Lastly, we summarize the results from the current literature of sperm retrieval, as well as the clinical outcome of ICSI in the clinical scenario of obstructive and nonobstructive azoospermia.

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Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

Section: Sperm Retrieval Postoperative Care and Complicationsmentioning

confidence: 99%

Section: Sperm Retrieval Success Rates and Intracytoplasmic Sperm Injmentioning

confidence: 99%

Section: Non-obstructive Azoospermiamentioning

confidence: 99%

See 2 more Smart Citations

Sperm retrieval techniques for assisted reproduction

Esteves¹,

Miyaoka²,

Agarwal³

2011

Int. braz j urol.

123

117

View full text Add to dashboard Cite

show abstract

“…Studies in the field seem to demonstrate that sperm retrieval in patients with NOA is quite an unpredictable factor, given that FSH, testicular volume, and other clinical characteristics have low sensitivity and specificity when their predictive ability is individually evaluated [4]. More recently, a couple of studies modeled a combination of some preoperative clinical parameters in the effort of achieving an higher diagnostic accuracy: Boitrelle et al [5] calculated a score from the combination of serum FSH and inhibin B levels plus testicular volume in patients undergoing conventional testicular sperm extraction (cTESE) obtaining an area under curve (AUC) value of 0.66, while Ramasamy and coworkers used an artificial neural network and were able to identify patients with or without testicular spermatozoa retrieved by microdissection testicular sperm extraction (microTESE) with a 60.8 % diagnostic accuracy [6].…”

Section: Introductionmentioning

confidence: 99%

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Caroppo¹,

Colpi

Gazzano

et al. 2016

J Assist Reprod Genet

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Purpose The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE). Methods We retrospectively evaluated 356 patients with nonobstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.Results The mean patients' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and −LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001) Conclusions This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.

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