Testicular fine needle aspiration: the alternative method for sperm retrieval in non-obstructive azoospermia

Lewin, Aby; Reubinoff, Benjamin; Porat-Katz, Anat; Weiss, David B.; Eisenberg, V. H.; Arbel, Ron; Bar-el, Hagar; Safran, Anat

doi:10.1093/humrep/14.7.1785

Cited by 96 publications

(79 citation statements)

References 34 publications

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“…A total of 90% of the case are classical, 46 XXY, while only 10% of the cases show mosaic 47 XXY/46 XXY. Sperm retrieval is possible despite a poor testicular histology and fertilization as well as pregnancy is reported in cases in which sperm have been utilized for ICSI (30). One out of 20 oligozoospermic males has abnormal karyotypes, mainly Robertsonian and reciprocal translocation.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory evaluation of idiopathic male infertility in a secondary referral center in India

Abid

Maitra

Meherji

et al. 2008

Clinical Laboratory Analysis

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The genetic basis of infertility has received increasing recognition in recent years, particularly with the advent of assisted reproductive technology. It is now becoming obvious that genetic etiology for infertility is an important cause of disrupted spermatogenesis. Y-chromosome microdeletions and abnormal karyotype are the two major causes of altered spermatogenesis. To achieve biological fatherhood, intracytoplasmic sperm injection (ICSI) is performed in cases of severe infertility with or without genetic abnormalities. There is a concern that these genetic abnormalities can be transmitted to the male progeny, who may subsequently have a more severe phenotype of infertility. A total of 200 men were recruited for clinical examinations, spermiograms, hormonal profiles, and cytogenetic and Yq microdeletion profiles. Testicular biopsy was also performed whenever possible and histologically evaluated. Genetic abnormalities were seen in 7.1% of cases, of which 4.1% had chromosomal aberrations, namely Klinefelter's mosaic (47XXY) and Robertsonian translocation, and 3.0% had Yq microdeletions, which is very low as compared to other populations. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased in men with nonobstructive azoospermia (NOA) as compared to severe oligoasthenozoospermia (Po0.0001), whereas testosterone levels were significantly decreased in men with microdeletions as compared to men with no microdeletions (Po0.0083). Low levels of androgen in men with microdeletions indicate a need to followup for early andropause. Patients with microdeletions had more severe testicular histology as compared to subjects without deletions. Our studies showed a significant decrease (Po0.002) in the serum inhibin B values in men with NOA, whereas FSH was seen to be significantly higher as compared to men with severe oligoasthenozoospermia (SOAS), indicating that both the Sertoli cells as well the germ cells were significantly compromised in cases of NOA and partially affected in SOAS. Overall inhibin B in combination with serum FSH would thus be a better marker than serum FSH alone for impaired spermatogenesis. In view of the genetic and hormonal abnormalities in the group of infertile men with idiopathic severe oligozoospermia and NOA cases, who are potential candidates for ICSI, genetic testing for Y-chromosome microdeletions, karyotype, and biochemical parameters is advocated.

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Section: Discussionmentioning

confidence: 99%

Clinical and laboratory evaluation of idiopathic male infertility in a secondary referral center in India

Abid

Maitra

Meherji

et al. 2008

Clinical Laboratory Analysis

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“…There is only one reported complication requiring surgical correction, which was testicular bleeding managed with hemostatic suturing [2,3,[13][14][15][16][17] . Hematomas can occur and tend to reabsorb within 1-4 weeks [8] .…”

Section: Discussionmentioning

confidence: 99%

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

Chow

Levine

2017

JGS

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Objective: To evaluate the sperm-retrieval rate (SRR) of testicular sperm aspiration (TESA) for men with presumed non-obstructive azoospermia (NOA) without prior genetic testing or testicular biopsies and to examine the correlation of successful sperm retrieval and FSH level. Patients and Methods:The complete records of 148 azoospermic men without clinical evidence of obstructive etiologies who underwent TESA from 1999 -2016 were reviewed. Preoperative diagnostic biopsies were not obtained and thus men with presumed NOA were defined as having no evidence of obstruction by history or physical examination. Preoperative FSH and testosterone were obtained for all patients. Two subgroups of NOA were evaluated (Group 1 with FSH > 10 IU/L and Group 2 with FSH ≤ 10). Results: Of our 148 patients, we identified 66 (45%) in Group 1 and 82 (55%) in Group 2. Sperm was successfully obtained from 19/66 (28.7%) in Group 1 and 56/82 (68%) in Group 2. Average FSH for Group 1 and Group 2 were 20.4 (10 -66) IU/L and 4.6 (1.1 -9.4) IU/L respectively. There were no postoperative adverse events including prolonged pain, infection, hematoma, hydrocele or testicular atrophy. Conclusion: TESA appears to offer a reasonably high likelihood of viable sperm retrieval in men with NOA. Given the higher level of SRR for men with presumed NOA with normal range of FSH (≤ 10 IU/L), we recommend that TESA should be considered the initial approach to retrieve sperm in this population as it is a quicker, easier, less invasive and likely a less costly approach to micro-TESE.

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“…21 Turek and colleagues 1,22 observed a 47% sperm detection rate among 96 consecutive infertile non-obstructive azoospermic patients receiving a mean of 7.6 FNA sites per testicle and a 52% detection rate in 87 men who received a mean of 14 FNA sites/testis. In a study done by Lewin et al 15 on 85 azoospermic men with non-obstructed testis, testicular FNA identified mature spermatozoa in 58.8% from a mean of 15 aspiration sites (range 10-20) per testicle. Finally, a recent analysis of over 100 recent FNA mapping procedures suggests that a sperm detection rate of 60% is possible by using 18 sites/testicle (unpublished data).…”

Section: Sperm Detection By Fna Mappingmentioning

confidence: 97%

“…This is consistent with the findings from other reports and suggests that bilateral examinations are crucial to informing men with non-obstructive azoospermia fully about opportunities for fatherhood. 15,23 In the subgroup of men with no spermatozoa on a prior testicular biopsy, FNA maps (mean: 7.6 sites/testis) revealed spermatozoa in 27% of cases. FNA mapping results have also been analyzed to determine whether particular geographical sites in the testis are more likely to have spermatozoa than others.…”

Section: Sperm Detection By Fna Mappingmentioning

confidence: 97%

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The value of testicular ‘mapping’ in men with non-obstructive azoospermia

Beliveau¹,

Turek²

2011

Asian J Androl

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As the field of assisted reproduction has advanced, many previously untreatable men are now biological fathers. Although finding sperm in men with obstructive azoospermia is not difficult, locating and retrieving spermatozoa in men with non-obstructive azoospermia remains a clinical challenge, largely because sperm production in these men can be patchy or focal in nature. In response to this challenge, strategies such as fine-needle aspiration (FNA) mapping have been developed to find spermatozoa. This review discusses the history, evolution and current clinical utility and findings with FNA mapping for male infertility). Review of the current literature in the English language on FNA (diagnostic or therapeutic) with a keyword focuses on sperm detection, retrieval, safety and complications. FNA was described in human medicine over 100 years ago. Testis FNA was described 45 years ago and FNA 'mapping' of spermatozoa was described in 1997. This comparative review of the literature on sperm detection and complication rates with FNA and open testis biopsy or microdissection procedures suggests that FNA is highly informative, minimally invasive and is associated with fewer complications than other commonly used approaches to sperm detection in non-obstructive azoospermic patients. FNA mapping has gained considerable traction as an informative, 'testis sparing' technique for sperm detection in non-obstructive azoospermia. With knowledge of sperm presence and location prior to sperm retrieval, FNA maps can help clinicians tailor sperm retrieval to optimize time, effort and extent of procedures needed to procure spermatozoa in these difficult cases.

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Testicular fine needle aspiration: the alternative method for sperm retrieval in non-obstructive azoospermia

Cited by 96 publications

References 34 publications

Clinical and laboratory evaluation of idiopathic male infertility in a secondary referral center in India

Clinical and laboratory evaluation of idiopathic male infertility in a secondary referral center in India

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

The value of testicular ‘mapping’ in men with non-obstructive azoospermia

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