Testicular Damage following Testicular Sperm Retrieval: A Ram Model Study

Fedder, Jens; Marcussen, Niels; Fedder, Maja D.K.; Engvad, Birte

doi:10.1155/2017/2472805

Cited by 11 publications

(9 citation statements)

References 37 publications

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“…In certain cases, there is persistent sonographic evidence of scar tissue along the biopsy site (Ramasamy et al, 2005;Schlegel & Su, 1997). Signs of acute damage identified with histological samples of testicular tissue following sperm extraction have been TA B L E 1 Baseline characteristics of the TESA and micro-TESE cohorts corroborated in animal studies as well (Barroso et al, 2018;Fedder et al, 2017). However, the long-term effects of TESA and micro-TESE on spermatogenic function have not been widely documented.…”

Section: Discussionmentioning

confidence: 99%

Does testicular sperm retrieval adversely impact spermatogenesis over the long‐term?

2022

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Infertility is a pervasive issue worldwide and is estimated to have male factor contributions in 20% to 70% of all couples due to various possible aetiologies (Agarwal et al., 2015;Babakhanzadeh et al., 2020). The demand for assistive reproductive technologies has increased globally as affordability and access to them continue to improve (Inhorn & Patrizio, 2015).Testicular sperm retrieval (TSR) techniques, including testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (micro-TESE), are valuable in the context of severe idiopathic male factor infertility as they enable infertile men to father children when coupled with intracytoplasmic sperm injection (ICSI) (Alharbi et al., 2021;Bernie et al., 2015;Palermo et al., 1992). The use of testicular spermatozoa in ICSI is supported by studies demonstrating that sperm transit in the post-testicular milieu induces sperm DNA damage in certain individuals; extracting testicular sperm bypasses transit associated damage, which is associated with high pregnancy and live birth rates (Aboukhshaba et al., 2021;Greco et al., 2005;Mehta et al., 2015).Ramasamy, et al. evaluated the effects of conventional TESE and micro-TESE and found that micro-TESE was associated with fewer structural changes on ultrasound compared to conventional TESE. In both cases, structural changes persisted up to six months. They also demonstrated a return to pre-micro-TESE testosterone level after 18 months (Ramasamy et al., 2005). Furthermore, a recent review

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Section: Discussionmentioning

confidence: 99%

Does testicular sperm retrieval adversely impact spermatogenesis over the long‐term?

2022

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“…This can make subsequent micro-TESE more difficult and is associated with a lower SRR. 21,24 Second, the small testicular tissue specimen obtained may not represent the whole testicular tissue, and different areas may have different histological patterns. Third, even a negative predictive histology of Sertoli-cells only will still result in a 47.2% SRR according to our data.…”

Section: Discussionmentioning

confidence: 99%

“…First, there will be some testicular fibrosis created by the biopsy. This can make subsequent micro‐TESE more difficult and is associated with a lower SRR 21,24 . Second, the small testicular tissue specimen obtained may not represent the whole testicular tissue, and different areas may have different histological patterns.…”

Section: Discussionmentioning

confidence: 99%

Micro‐testicular sperm extraction outcomes for non‐obstructive azoospermia in a single large clinic in Victoria

Lantsberg

Mizrachi

Katz

2022

Aust NZ J Obst Gynaeco

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Aims To evaluate the results of microdissection testicular sperm extraction (micro‐TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non‐obstructive azoospermia (NOA). Materials and methods We retrospectively analysed data of 88 consecutive patients with clinical NOA who were treated with micro‐TESE by a single surgeon, between August 2014 and September 2020, in Melbourne, Victoria. Upon a successful sperm retrieval, sperm was either used fresh for ICSI, frozen for future use or both. The outcome measures were sperm retrieval rate (SRR), and in vitro fertilisation (IVF)/ICSI results. Furthermore, SRR was calculated for the predominant causes and histopathological patterns. Results The overall SRR was 61.2%. It was significantly higher in patients with a history of cryptorchidism and other childhood diseases (100%) than in the other NOA groups (P < 0.05). Patients with Klinefelter syndrome had a 75% SRR. Among the different types of testicular histology, the highest SRR were noted in patients with complete hyalinisation (100%) and hypospermatogenesis (92.9%), and low with Sertoli cell‐only syndrome (46.3%). The SRR has significantly increased from 33.3% in 2015–2016 to 73.6% in 2019–2020 (P = 0.009). Of the 52 patients with SSR, 47 underwent IVF/ICSI. Fertilisation rate was 42.4%. Twenty‐nine couples achieved at least one good‐quality embryo and had embryo transfer. Nineteen achieved pregnancy (40.4%), and in three patients a miscarriage resulted. Conclusions This is the first report from Australia showing that micro‐TESE is an effective treatment for NOA with high SRR. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.

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“…Unfortunately, Phillipson et al 33 did not have sufficient power to distinguish between use of epididymal and testicular spermatozoa. Unless reconstructive surgery of the genital tract might be considered, it is always worth to consider retrieval of spermatozoa from the epididymis to avoid the risk of testicular traumas 34 . However, in patients with CFTR mutations and CBAVD the testicles use to be of normal size, and therefore, it is usually very easy to perform a testicular needle biopsy with a very low risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of CBAVD in azoospermic men carrying pathogenic CFTR mutations ‐ Evaluated in a cohort of 639 non‐vasectomized azoospermic men

2020

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Background Men with obstructive azoospermia (OA) due to impaired development of the genital tract often carry at least one Cystic Fibrosis Transmembrane Conductance Regulator CFTR mutation. Objective To determine the frequency of Congenital Bilateral Absence of Vas deferens (CBAVD) in men with azoospermia carrying CFTR gene mutations. Materials and methods Non‐vasectomized men with azoospermia referred to our andrological center were consecutively included. All men underwent palpation of the scrotal parts of the Vasa deferentia, ultrasonography of the testicles and hormone profile, and genetic analyses. Testicular biopsy was usually performed. A panel of 32 of the most important CFTR mutations was examined from genomic DNA isolated from blood lymphocytes. Either multiplex PCR analysis or a next‐generation sequencing technique was performed. Results Among the 639 men with azoospermia, 69 (10.8%) had at least one CFTR mutation. Of the 43 patients with at least one of the two CFTR mutations, ΔF508 and R117H, 19 (44.2%) showed CBAVD, 2 (4.7%) Congenital Unilateral Absence of Vas deferens (CUAVD), and 22 (51.2%) presence of the scrotal parts of the Vasa deferentia. In contrast, only 1/21 men (4.8%) with an isolated IVS8‐5T variant showed CBAVD. Among the further 20 men with an isolated IVS8‐5T variant, 11 had a history of cryptorchidism. Among the 570 men without CFTR mutations, CBAVD was found in only two men and CUAVD in one. FSH level was higher and testicular volume lower in men with present Vasa deferentia compared to those without (P < .001; Student's t test). Thirty‐one men with either ΔF508 or R117H mutations, or both, had a testicular biopsy. Motile spermatozoa were found in 100% of 16 cases with CBAVD but in only 6 out of 15 cases with present Vasa deferentia (P < .01; Fisher's exact test). Discussion and conclusions CBAVD was found in ~ 44% of men with ΔF508/R117H mutations. The data may support that CFTR mutations might affect male fertility through other mechanisms than obstruction of the genital tract. For a practical, clinical purpose analysis for only ΔF508, R117H and IVS8‐5T seems sufficient until further research shows anything else.

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Testicular Damage following Testicular Sperm Retrieval: A Ram Model Study

Cited by 11 publications

References 37 publications

Does testicular sperm retrieval adversely impact spermatogenesis over the long‐term?

Does testicular sperm retrieval adversely impact spermatogenesis over the long‐term?

Micro‐testicular sperm extraction outcomes for non‐obstructive azoospermia in a single large clinic in Victoria

Prevalence of CBAVD in azoospermic men carrying pathogenic CFTR mutations ‐ Evaluated in a cohort of 639 non‐vasectomized azoospermic men

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