Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro–tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia?

Alkandari, Mohammad H; Moryousef, Joseph; Phillips, Simon; Zini, Armand

doi:10.1016/j.urology.2021.04.037

Cited by 18 publications

(8 citation statements)

References 24 publications

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“… 53 A study performed testicular sperm extractions in 56 men with cryptozoospermia and found that 88% of the men (42/48) who underwent M‐TESE and 25% of the men (2/8) who underwent TESA had successful sperm retrieval. 54 In addition, 96% of the cryptozoospermic men (23/24) who underwent M‐TESE could receive sperm from the testis, but only 43% of the men (3/7) could receive sperm who underwent TESA , and the pregnancy rates of intracytoplasmic sperm injection ( ICSI ) in these groups could reach 33% (6/18). Thus, M‐TESE is a successful sperm extraction technique for men with cryptozoospermia.…”

Section: Resultsmentioning

confidence: 99%

“…Studies have shown that testicular sperm aspiration ( TESA ) and M‐TESE have the same effect on sperm retrieval in men with severe oligospermia, but M‐TESE has a significantly higher sperm recovery rate than TESA in men with cryptozoospermia 53 . A study performed testicular sperm extractions in 56 men with cryptozoospermia and found that 88% of the men (42/48) who underwent M‐TESE and 25% of the men (2/8) who underwent TESA had successful sperm retrieval 54 . In addition, 96% of the cryptozoospermic men (23/24) who underwent M‐TESE could receive sperm from the testis, but only 43% of the men (3/7) could receive sperm who underwent TESA , and the pregnancy rates of intracytoplasmic sperm injection ( ICSI ) in these groups could reach 33% (6/18).…”

Section: Resultsmentioning

confidence: 99%

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Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review

Liu

Luo²,

Chen

et al. 2022

Health Science Reports

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Background and Aims Cryptozoospermia is an extreme oligozoospermia with an unsatisfactory treatment effect, with an incidence rate of approximately 8.73% in male infertility, whose effective solution has become the call of the times. Western Medicine has achieved certain effects through drugs, surgery, and assisted reproductive therapy, but this is still not ideal. Traditional Chinese medicine ( TCM ) has made many achievements in other disciplines; however, there is still a lack of evidence‐based medical evidence to improve sperm production. Methods The relevant literatures from the China National Knowledge Internet ( CNKI ) and PubMed in the past 10 years were collected in this article, of which the mechanisms, advantages, or current controversies of various treatment methods of Western Medicine and TCM were analyzed, to find new treatment methods and research directions. Results With the development of modern science and technology, medical treatments for cryptozoospermia have become increasingly abundant; however, there is still no universally recognized unified and effective guiding plan. Although TCM has not been fully verified by evidence‐based medicine, most TCM combined with Western Medicine can achieve unexpected results. Conclusion The combination of TCM and Western Medicine may become a bane for cryptozoospermia and bring good news to infertile men worldwide.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review

Liu

Luo²,

Chen

et al. 2022

Health Science Reports

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“…Prior to undergoing sperm retrieval procedures, each case was reviewed by a multi-disciplinary team (urologist, gynaecologist and embryologist). The options presented to couples were as follows: (1) ICSI with fresh or previously frozen and thawed ejaculated spermatozoa, (2) ejaculated spermatozoa and TESA being offered as a second-line alternative if no viable ejaculated spermatozoa are found, (3) immediate TESA (limited to 2 aspirations per testicle to minimize injury) with the understanding that TESA has an estimated sperm retrieval rate (SRR) of 88% to 100% in oligozoospermia and a modest SRR of ~44% in cryptozoospermia (Alharbi et al, 2021;Alkandari et al, 2021;Alrabeeah et al, 2015), ( 4) immediate micro-TESE, which is more invasive but has a higher estimated SRR of 90% to 96% in oligozoospermia and cryptozoospermia (Alkandari et al, 2021;Alrabeeah et al, 2014Alrabeeah et al, , 2015. Couples were explained the potential benefits and risks of testicular sperm retrieval (bleeding, infection, pain, hypogonadism, irreversible testicular dysfunction).…”

Section: Patientsmentioning

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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“…In a Canadian study designed to compare SR outcomes by TESA or micro-TESE in men with NOA, the authors showed better SR success rates in patients undergoing micro-TESE, when compared to those submitted to TESA (88 vs. 25%, p = 0.0006). However, sperm concentration was significantly higher in men undergoing TESA when compared to those undergoing micro-TESE (1.2 ± 1.5 × 106/ml vs. 0.3 ± 0.5 × 106/ml, p = 0.012) ( 35 ).…”

Section: Techniques For the Treatment Of Non-obstructive Azoospermiamentioning

confidence: 99%

Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?

Vieira

Andrade²,

Santana–Santos

2022

Front. Reprod. Health

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Men presenting with non-obstructive azoospermia are the most challenging clinical scenario for an infertile couple. Intracytoplasmic Sperm Injection (ICSI) with testicular sperm retrieval gave a chance for biological fatherhood once sperm can be found, but unfortunately sperm recovery rate (SSR) is something near 50%, leading to a discussion about what surgical retrieval technique is the best. Historically sperm have been retrieved using conventional Testicular Sperm Extraction (c-TESE), Testicular Sperm Aspiration (TESA), a combination of Testicular Fine Needle Aspiration (TfNA)/c-TESE, Testicular Microdissection (TM) and Open Testicular Mapping (OTEM). c-TESE published in 1995 by Devroey and cols. consists of testis delivery, a large unique albuginea incision and extraction of a portion from the majority of testicular tubules. TESA published in 1996 by Lewin and cols. is done percutaneously using a 21–23 gauge needle and a syringe to aspire testicular tubules. TfNA was published in 1965 by Obrant and Persson as an aspiration biopsy and cytological exam to verify sperm production. In 1999 Turek and cols. published the use of TfNA combined with c-TESE for sperm retrieval. In 1999, Peter Schlegel published a technique using a microsurgical approach to identify more probable sperm production areas inside the testicle that could be excised with better precision and less tissue. OTEM is a multiple biopsy approach, published in 2020 by Vieira and cols., based on TfNA principles but done at the same time without albuginea opening or surgical microscope need. Since Testicular Microdissection publication, the method became the gold standard for sperm retrieval, allowing superior SSR with minimal tissue removal, but the amount of testicular dissection to find more probable spermatogenesis areas, difficulties in comparative design studies, diversity TM results among doctors and other methods that can achieve very similar results we question TM superiority. The objective is review existing literature and discuss advantages and disadvantages of all the methods for sperm retrieval in non-obstructive azoospermia.

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Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro–tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia?

Cited by 18 publications

References 24 publications

Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review

Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review

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

Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?

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