Physiological consequences of testicular sperm extraction

Abstract

Testicular sperm extraction (TESE) may provide spermatozoa for attempts at fertility with assisted reproduction; however, the physiological effects of TESE on testicular function are not well understood. In order to evaluate the effects of TESE on the testis, 64 patients were evaluated after TESE for non-obstructive azoospermia with physical examinations, serial scrotal sonography, histological analyses and evaluation of the success of repeated sperm retrieval attempts. At 3 months after TESE, 82% of evaluated patients had ultrasonographic abnormalities in the testis suggesting resolving inflammation or haematoma at the biopsy site. By 6 months, these acute inflammatory changes typically resolved leaving linear scars or calcifications. Two patients had documented impaired testicular blood flow, with complete devascularization of the testis for one patient after TESE with multiple biopsies. Repeat TESE procedures were far more likely to retrieve spermatozoa if the second TESE attempt was performed >6 months after the initial TESE procedure (80%), relative to those performed within 6 months (25%). Transient adverse physiological effects are common in the testis for up to 6 months after TESE. In addition, permanent devascularization of the testis can occur following TESE procedures with multiple biopsies. The risk of this complication may be minimized by using an open biopsy technique with optical magnification to directly identify testicular vessels.

Traitement de l’azoospermie obstructive par injection Intracytoplasmique d’un spermatozoïde

“…In contrast, Ramasamy et aL, [67] found a significant decrease in testosterone three to six months after TESE surgery with concomitant increases in follicle stimulating hormone and luteinizing hormones. Pathological consequences of biopsying have also been reported by Schlegel et aL [73] with a high incidence of both inflammation and haematomas and also devascularization in a small number of patients. Animal studies have allowed more detailed investigations of the impact of repeated testicular aspirations.…”

“…This is followed by an examination of the patient together with history, endocrine profile and karyotyping. Until recently it has been accepted that normal levels of FSH and LH are predictive of the presence of sperm in the seminiferous tubules [73]. Inhibin B has also be suggested as a useful predictor [7].…”

Overview of male infertility

“…La limitation pratique semble ~tre la r6cup6ration des quelques spermatozo'~'des situ6s dans quelques tubes s6minif'eres chez des sujets pr6sentant des azoospermies par hypospermatog6n~se s6v~re [58]. I1 faut toutefois prendre en compte le fait que des troubles de la vascularisation du parenchyme testiculaire s'observent apr~s des pr61~vements biopsiques multiples pour extraction de spermatozoades [47]. I1 apparait ainsi n6cessaire d'espacer des pr61~vement testiculaires it6ratifs de plus de 6 mois et de de tenir compte de la vascularisation intratesticulaire lors de la r6alisation des pr61~vements.…”

The Levels of Oxidative Stress Biomarkers in Rats as a Response to Different Techniques of Testicular Biopsy

“…Complications associated with surgical sperm retrieval techniques are haematoma and fibrosis, identified at ultrasound in the months immediately following the procedure [19]. Testicular atrophy and devascularization are considered to be long-term physiological complications [20].…”