Multiple needle‐pass percutaneous testicular sperm aspiration as first‐line treatment in azoospermic men

Abstract

SUMMARYPercutaneous testicular sperm aspiration (TESA) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates (SRR) when compared with microdissection testicular sperm extraction (mTESE), many centers now use mTESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia (NOA). Objectives of this study were to evaluate the outcome and safety of TESA and mTESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle-pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia (OA). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to mTESE. Main outcome measures were complication rates and SRR. SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA. In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with mTESE. Overall complication rates of TESA and mTESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA. Men with a failed TESA have a limited chance of sperm retrieval using mTESE. Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or mTESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.

Testicular needle aspiration: Is it a safe method for breeding soundness evaluation in bulls?

“…TNA allows the recovery of spermatogenic cells directly from the testis and can be used for several research purposes (Jha and Sayami, 2009;Mallidis and Baker, 1994), without depending on the collection and evaluation of semen as a semiological method for the evaluation of male fertility (Papa and Leme, 2002). The amount of spermatogenic cells obtained from TNA has a positive correlation with open testicular biopsies, demonstrating that testicular fine-needle aspiration is the method of choice for investigation of azoospermia in men (Adhikari, 2009;Jensen et al, 2016).…”

New promising strategies in oncofertility

“…This is also an option for cancer survivors who are azoospermic, as sometimes there are a few errant sperm in the epididymis that can be collected [37, 38]. Electroejaculation (EEJ) offers an additional alternative for patients unable to masturbate to produce sperm, using electrical stimulation via a rectal probe to stimulate ejaculatory organs [34, 35, 39].…”

Understudied and Under-Reported: Fertility Issues in Transgender Youth—A Narrative Review

“…44 Noninvasive methods (masturbation) are preferred, though sperm may be retrieved by electroejaculation 45 or extracted with percutaneous aspiration or microdissection extraction of the testicular sperm for those who are unwilling or unable to masturbate, or who are azoospermic. 46,47 These alternate methods could benefit individuals whose erections have decreased after starting gender-affirming therapy, or for those who experience psychological distress with masturbation. At present, testicular tissue cryopreservation for preand postpubertal assigned male subjects is an experimental fertility preservation option 48,49 ; because no human births have been reported to date, this procedure should only be performed under an institutional review board-approved protocol for those who are at high risk for infertility.…”