Surgically Extracted Epididymal Sperm from Men with Obstructive Azoospermia Results in Similar In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes Compared with Normal Ejaculated Sperm

Hayon, Solomon; Moustafa, Sarah; Boylan, C.F.; Kohn, Taylor P.; Peavey, Mary; Coward, R. Matthew

doi:10.1097/ju.0000000000001388

Cited by 8 publications

(9 citation statements)

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“…In cases of untreatable epididymal obstructions, microsurgical epididymal sperm aspiration may be applied to harvest sperm for cryopreservation [ 7 , 9 , 10 , 78 , 79 ]. By contrast, a testicular sperm retrieval technique (e.g., conventional TESE or microdissection TESE) should be carried out in the same operative time if no signs of obstruction are seen [ 10 ].…”

Section: Differential Diagnosis In Cases Of Doubt: Testis Biopsymentioning

confidence: 99%

Differential Diagnosis of Azoospermia in Men with Infertility

Andrade

Viana

Esteves

2021

JCM

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The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.

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Section: Differential Diagnosis In Cases Of Doubt: Testis Biopsymentioning

confidence: 99%

Differential Diagnosis of Azoospermia in Men with Infertility

Andrade

Viana

Esteves

2021

JCM

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“…And our study showed the same result. Nonetheless, Solomon's population study showed no difference in the embryonic development of epididymal sperm between the OA group and the donor sperm group [9] . However, we noticed that the patients' obstructive interval, which was reported to be positively correlated with pregnancy rate, was not mentioned in their study [42] .…”

Section: Discussionmentioning

confidence: 93%

“…The clinical treatment for OA includes microsurgical reconstruction of the reproductive tract and sperm retrieval for ICSI. The OA patients' post-testicular sperm maturation is in an abnormal epididymal environment because of the obstructive reproductive tract; therefore, the debate over whether OA affects sperm and results in abnormal embryonic development has continued; nevertheless, no de nite conclusion has been drawn regarding this issue [3][4][5][6][7][8][9] . The epididymis is an important organ for post-testicular sperm maturation, where sperm acquires proteins, sRNAs, forward ability, and fertilization capability [10] .…”

Section: Introductionmentioning

confidence: 99%

Developmental miR-17-92 cluster and sfmbt2 miRNA cluster can’t rescue the abnormal embryonic development caused by the obstructive epididymal environment

Liu

et al. 2022

Preprint

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Background Sperms during epididymal transit acquire microRNAs(miRNAs), which are crucial for embryonic development. However, whether miRNAs transmitted from an obstructive epididymal environment affect embryonic development remains unknown. The purpose of the present study was to investigate the effects of an obstructive epididymal environment on embryonic development. Method The control group (CON) and the obstructive epididymal environment group(OEE) were treated with sham operation and vasectomy, respectively. The effects of an obstructive epididymal environment on testis, epididymis, sperm, and embryonic development were analyzed via hematoxylin and eosin staining (HE staining), sperm quality test, epididymosomes fusion, intracytoplasmic sperm injection (ICSI) and embryo transfer. Moreover, sRNA sequence, RT-qPCR, and DNA methylation were conducted to investigate the regulation of sperm miRNAs by an obstructive epididymal environment. miRNAs microinjection and embryo transfer were used to explore the impacts of sperm miRNAs on embryonic development. Results The long obstructive interval impaired the morphology of the testis and epididymis. In comparison to the CON group, the OEE group had lower sperm quality and developmental potential. Sperm miRNAs profiles were also altered in the OEE group, particularly the developmental miR-17-92 cluster and Sfmbt2 miRNA clusters; the expression of these two miRNA clusters was regulated via epididymal DNA methylation; however, the disruption of neither the miR-17-92 cluster nor the Sfmbt2 miRNA clusters into normal zygotes did not impair embryonic development. Conclusion The obstructive epididymal environment influences embryonic development and the abundance of the sperm miR-17-92 cluster and the sfmbt2 miRNA cluster, but these miRNA clusters are not the cause of abnormal embryo development. It implies that epididymis is important in early embryonic development and may play a potential role in sperm epigenome.

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“…Others report better pregnancy rates with epididymal sperm than testicular sperm when sperm are selectively retrieved and used from the best areas of the epididymis using MESA [38]. Recent work by Hayon et al [39 ▪ ] suggests that the probability of IVF success with epididymal sperm in OA men is not worse than the probability of IVF success with ejaculated sperm in men with normal semen parameters. In their retrospective comparison of IVF outcomes in 40 couples with OA in the male partner and normal female factor using epididymal sperm vs. 38 age-matched control couples with normal fertility using ejaculated sperm, both groups had similar rates of pregnancy (59% vs. 61%, P = 1.0) and live birth (52% vs. 43%, P = 0.5).…”

Section: Obstructive Azoospermiamentioning

confidence: 99%

Modern surgical treatment of azoospermia

Brant¹

2022

Current Opinion in Urology

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Purpose of reviewTo review noteworthy research from the last 2 years on surgical management of azoospermia.Recent findingsThe recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue.SummaryMost men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification.

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Surgically Extracted Epididymal Sperm from Men with Obstructive Azoospermia Results in Similar In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes Compared with Normal Ejaculated Sperm

Cited by 8 publications

References 0 publications

Differential Diagnosis of Azoospermia in Men with Infertility

Differential Diagnosis of Azoospermia in Men with Infertility

Developmental miR-17-92 cluster and sfmbt2 miRNA cluster can’t rescue the abnormal embryonic development caused by the obstructive epididymal environment

Modern surgical treatment of azoospermia

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