Tissue Perfusion Essential for Spermatogenesis and Outcome of Testicular Sperm Extraction (TESE) for Assisted Reproduction

Abstract

Purpose : In order to determine if there are areas of major and minor perfusion in a single testicle and if the quality of sperm is correlated with quantity of perfusion we collected testicle tissue for TESE in accordance to the local testicle tissue perfusion. Methods : A patient undergoing TESE underwent testicular perfusion mapping using contrast enhanced ultrasound. The exposed tissue was scanned with a Laser Doppler scanner and perfusion rates were determined measuring tissue perfusion units (TPUs). Tissue was biopsied and sperm were selected and prepared for assisted reproduction. Results : The total amount of isolated sperm correlated highly with the intensity of tissue perfusion showing high number of sperm in areas with high TPUs. Conclusions : This is the first demonstration that sperm quality and quantity is depending on tissue perfusion within the testicle. To further improve infertility treatment we propose that random biopsies could be replaced by perfusion-dependent collection of testicular tissue.

No relationship between biopsy sites near the main testicular vessels or rete testis and successful sperm retrieval using conventional or microdissection biopsies in 220 non-obstructive azoospermic men

“…Our findings conflict with the results of other groups that found a relationship between blood flow, as measured by ultrasound, and sperm-positive biopsies in small cohorts of patients with NOA. [3][4][5] As we did not use Doppler ultrasound or laser Doppler flowmetry but instead assessed testicular vascularisation through an operative microscope, these conflicting results might be explained by different methodologies. However, our findings concur with the assessment of Ramasamy et al 17 Based on the experience of 900 men who underwent M-TESE for NOA between 2000 and 2010, Ramasamy et al 17 believe that a close correlation does not exist between testicular blood flow and the areas of spermatogenesis in patients with NOA, although this correlation was not specifically studied during their investigations.…”

“…However, small studies have suggested a correlation between testicular perfusion and focal spermatogenesis. 3,4 In a study of 12 patients with NOA, sperm quality was highest in areas of high tissue perfusion, as determined by Doppler ultrasound and laser Doppler flowmetry. 5 Schlegel observed that sperm-containing regions can be identified microsurgically, as seminiferous tubules that contain many developing germ cells, rather than Sertoli cells alone, are likely to be larger and more opaque than tubules without sperm production.…”

A new method to process testicular sperm: combining enzymatic digestion, accumulation of spermatozoa, and stimulation of motility

“…microdissection TESE) may be required [9][10][11]. In this context, fine-needle aspiration mapping prior to TESE [12] or tissue perfusion-controlled guided biopsies [13] turned out to be useful to locate areas of spermatogenesis.…”

Varicocele and the Outcomes of Microdissection Testicular Sperm Extraction in Non-Obstructive Azoospermia: A Case-Control Study

“…In fact, varicocele is believed to be among the most common correctable etiologies of infertility in men [9]. Vascular perfusion appears to affect the quality of spermatogenesis [30]. Indeed, several reports have shown associated derangements in semen parameters when varicocele is present [11,12], and shown improvements when varicocele is corrected [8,10,14,15,22,31,32].…”