Sperm retrieval techniques for assisted reproduction

Abstract

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.

Sperm analysis of the vas deferens fluid after a long interval of unilateral percutaneous epididymal sperm aspiration in vasectomized patients

“…After the report of the first ICSI (7), PESA became progressively used to recover sperm in vasectomized patients, since it is a very simple techni-que, but with the inconvenience of contraindicating a future VV (3,8).…”

“…In order to obtain spermatozoa to ICSI some surgical techniques are employed, as percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), testicular sperm extraction (TESE) and microsurgical dissection of seminiferous tubules (microTESE) (2)(3)(4). It is still possible to use microsurgical epididymal sperm aspiration (MESA) (5)(6)(7), during which it is performed a microsurgical repair of the epididymal tubule in order to avoid posterior obstructive scarring of the tubules keeping them patent.…”

“…Classically, PESA is considered a recovery technique that causes obstruction of epididymal tubules (3,8). The mechanism of obstruction is related to scarring after the use of the aspiration needle and leakage of spermatozoa.…”

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

“…Once fertilized, the embryo is implanted into female uterus for development. (10,11) The sperm recovery rates ranges from 90% to 100% for obstructive azoospermia using any of standard surgical technique (12) , but the sperm recovery rates for non-obstructive azoospermia range from 30-63% for TESE, and 43-63% for Micro-TESE; the rate for TEFNA is approximately 47%. (17) Out of all patients of azoospermia approximately 36% are due to obstructive azoospermia.…”

Fresh Versus Frozen Testicular Sperm Samples in Microdissection Testicular Sperm Extraction Intracytoplasmic Sperm Injection Treatment

“…It has been reported that sperm retrieval rates change between 35% and 77% for MD TESE procedures, and more importantly, MD TESE procedures have significantly better clinical outcomes than conventional TESE procedures or percutaneous aspirations (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”