The development of surgical sperm extraction and new challenges to improve the outcome

Abstract

Surgical sperm extraction with intracytoplasmic sperm injection has become widespread worldwide and is regarded as the sole option for patients with azoospermia. However, the sperm retrieval rate remains unsatisfactorily low, particularly for men with non-obstructive azoospermia (NOA). Therefore, the technical challenges associated with improving the sperm retrieval rate for men with NOA are being addressed. The most successful method developed to date is microdissection testicular sperm extraction (micro-TESE), which is rapidly becoming recognized as a useful technique due to its relatively high sperm retrieval rate and low complication rate. However, even with micro-TESE, the sperm retrieval rate for men with NOA remains at 30-60 %, with an even lower birth rate. The technical challenges associated with improving the outcomes of surgical sperm extraction are being approached through the use of ultrasound and optimal surgical devices such as narrow band imaging, multiphoton microscopy, and optical coherent tomography. In addition to the difficulties related to searching for sperm, medical treatments that induce spermatogenesis remain controversial. For example, varicocele repair prior to surgical sperm extraction and hormonal therapy before and after TESE have been extensively examined. We herein briefly summarized the development process in surgical sperm extraction up to the present and technical challenges to improve the outcomes of surgical sperm extraction.

Two Decades from the Introduction of Microdissection Testicular Sperm Extraction: How This Surgical Technique Has Improved the Management of NOA

“…The first description of testicular sperm for use in assisted reproduction occurred in 1993 [ 13 ]. Successful fertilization, embryo development, implantation and pregnancy was considered to be an unanticipated result by some reproductive experts given the expected need for additional maturation by sperm that was known to occur during epididymal transit [ 14 ].…”

“…This success was revolutionary for the treatment of men with NOA, but certain challenges remained given the sporadic, almost anecdotal, success of initial efforts to treat men with NOA who were previously considered to be sterile [ 16 ]. Based on observations that limited sperm was retrieved during simple biopsy, it was originally thought that multiple testis biopsies would increase the chance of retrieval as sperm production was believed to occur in isolated areas in the testis of men with NOA and spermatogenic failure [ 14 ]. In reality, multiple open biopsies resulted in removal of large quantities of testicular tissue and created a new risk, namely of harm to the blood supply of the testis from multiple incisions on the tunica albuginea.…”

Effect of vas ligation on testicular sperm extraction results in nonobstructive azoospermic rats: Shaeer’s lock‐in technique

“…(Kumar, 2013). NOA is either due to primary testicular impairment or secondary to pituitary insufficiency and subsequently inadequate gonadotropin production (Enatsu et al., 2015). In addition to hormonal replacement therapy (HRT) when indicated, management of patients with NOA involves testicular sperm extraction (TESE or microdissection TESE) and subsequent intracytoplasmic sperm injection (ICSI) (Abdel Raheem et al., 2013).…”

The role of surgical sperm retrieval techniques in patients with azoospermia in assisted reproductive technology programs (literature review)

“…Важно учитывать, что при TESA, в отличие от открытого хирургического вмешательства, врач не имеет возможности прямо контролировать риск кровотечения и немедленно восстановить целостность оболочек яичка. Следовательно, TESA проигрывает TESE и microTESE во многих аспектах, хотя она выполнима даже андрологами без серьезного хирургического опыта [39].…”