Sperm Retrieval Procedures and Intracytoplasmatic Spermatozoa Injection with Epididymal and Testicular Sperms

Abstract

Introduction: Male infertility caused by azoospermia due to non-reconstructable obstruction or non-obstructive azoospermia can be treated by microsurgical epididymal aspiration (MESA) or testicular sperm extraction (TESE) followed by an intracytoplasmatic spermatozoa injection (ICSI). Material and Methods: From 9/93 to 6/01, we carried out 1,025 ICSI procedures with aspirated epididymal or testicular sperms in 684 cases. 163 ICSI cycles were performed with epididymal sperms and 862 ICSI cycles with testicular sperms or spermatids. The TESE was carried out by open biopsy, frequently in a multilocular technique. The aspirated spermatozoas were used after cryopreservation (frozen) or immediately after aspiration (fresh). Results: 538 patients had obstructive azoospermia or ejaculation failure. In 487 cases the underlying cause of azoospermia was an impaired spermatogenesis, following maldescensus testis, chemotherapy, radiotherapy, or caused by Sertoli-cell-only syndrome, a genetic disorder or an unknown etiology. The transfer rates, pregnancy rates and birth rates per ICSI cycle showed no statistically significant differences between testicular and epididymal sperms in the cases of seminal obstruction (28% average birth rates in both cases). However, highly significant was the difference in birth rates with regard to the underlying cause of infertility. In contrast, in treating non-obstructive azoospermia we observed a birth rate of 19% per cycle. In all patient groups the birth rate with fresh spermatozoas did not differ from those with cryopreserved spermatozoa. 40% of patients after multilocular TESE showed clinical signs of testicular lesion. Conclusion: The underlying cause of azoospermia is the most important factor for the outcome of ICSI using epididymal and testicular sperms. In cases of non-obstructive azoospermia, the pregnancy rate is low compared with the results in cases of obstructive azoospermia. There is no difference between fresh and cryopreserved sperms. TESE with ICSI is the most efficient treatment of azoospermia caused by hypergonadotropic hypogonadism. The morbidity of the TESE procedure is highly relevant and must be considered if this technique is indicated.

Effect of sperm storage and selection techniques on sperm parameters

“…Thus, it is useful to cryopreserve surgically retrieved sperm samples in patients with OA/NOA as the outcomes are only affected by the type of azoospermia and not by the cryopreservation process itself [Schwarzer et al 2003]. …”

Prospective Study of Predictive Factors and Outcome in Sperm Retrieval of Azoospermic Males: Initial Experience in Tertiary Care Centre

“…Remaining 71(88.75 %) were diagnosed as non-obstructive azoospermia patients. Obstructive azoospermia accounts for 35 % to 40 % cases of azoospermic males as per larger studies (6,11,13,14) . In our study, men with obstructive azoospermia planned for surgical retrieval are only 11.25 %.…”

Gonadal dysfunction and fertility problems in cancer survivors

“…This should be done prior to initiation of cancer treatment, ideally also before orchiectomy in testicular cancer patients [26]. If retrieval of sperm by masturbation fails, which especially may be the case in young adolescents; other methods for sperm retrieval may be considered, like electroejaculation, electrovibration, microsurgical epididymal aspiration or testicular sperm cell extraction (TESE) [59,60]. The last two procedures may even reveal sperm in men with nonobstructive azoospermia, although the pregnancy rate following ICSI is lower in cases of non-obstructive than obstructive azoospermia [60].…”

“…If medical treatment fails, there are also other available methods for retrieval of sperms [59,60]. Testicular sperm cell extraction is also an opportunity in men with non-obstructive azoospermia following chemotherapy, and in one study, sperm were in such cases extracted in 70% (14/20), and parenthood was achieved by 8 of 12 couples where intracytoplasmatic sperm cell injection (ICSI) subsequently was performed (including one ongoing pregnancy at the end of the study period) [69].…”