Sperm retrieval techniques

Sperm Retrieval
Techniques
“Understanding Infertility” – New Delhi, India – August 2011
SandroEsteves, MD, PhD
Director, ANDROFERT
Center for Male Reproduction and Infertility
Campinas, BRAZIL
Esteves, 1

Learning Objectives
Esteves, 2

Azoospermia
It is not a synonymous of sterility

Obstructive Azoospermia
Sperm retrieval for ART
Epididymis
Testis
Simple and effective

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PERCUTANEOUS RETRIEVAL
Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and intracytoplasmic sperm injection (ICSI) in obstructive azoospermic (OA) men according to the cause of obstruction. Fertil Steril. 2010;94 (Suppl):S233.

Non-obstructive Azoospermia
Untreatable condition
Sperm Retrieval for ART
Sperm production reduced or absent
Geographic location unpredictable
TESA
TESE

Non-obstructive AzoospermiaTesticular Sperm Aspiration - TESA

Non-obstructive AzoospermiaTesticular microdissection - micro-TESE
Method to identify site(s) of production
Based on the diameter of seminiferous tubules
Microsurgical approach
Identify site of production
Preserve vasculature of testis
Small quantity of tissue excised
Schlegel, Hum Reprod 1999; 14

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Esteves, Androfert
Sperm Retrieval Rates in NOA are Related to Testicular Histopathology but not to the Etiology of Azoospermia
Esteves SC, Verza Jr S, Prudencio C, Seol B; FertilSteril 2010
176 NOA men (mean age 36.9 years)
Microdissection TESE or TESA
Classified according to the Etiology of NOA
Biopsy for histology concomitant or prior to SR
Hypospermatogenesis (HYPO)
Maturation Arrest (MA)
Sertoli Cell Only Syndrome (SCO)

SpermRetrievalandEtiologyof NOA
Etiology
Chi-square; NS
Esteves SC, Verza S, Prudencio C, Seol B. Sperm retrieval rates (SRR) in nonobstructive azoospermia (NOA) are related to testicular histopathology results but not to the etiology of azoospermia. FertilSteril. 2010;94(Suppl.):S132.

Esteves, Androfert
SpermRetrieval in NOA isrelatedto
Testicular Histopathology
Esteves SC et al FertilSteril 2010; 94:S132
Results (2): Micro-TESE X TESA
*TESA vs micro-TESE (MA + SCO): P=.03

Micro-TESE
39%
P=.03
Micro-TESE
TESA/TESE
N=131; *hypospermatogenesis excluded
Esteveset al.; FertilSteril 2010; 94:S132

Esteves, Androfert
Predictive Factors for Sperm Retrieval in NOA
Chance of finding sperm is dependent on the most advanced site of spermatogenesis within the testis
FSH
InhibinB
Testicular volume
Etiology
Testosterone levels
Testis histology
Reflect global spermatogenic function but not the most advanced site of sperm production in a dysfunctional testis

Predictive Factors for Sperm Retrieval in NOAY Chromosome Microdeletion
AZFa deleted
Germ cell Aplasia
No retrievable sperm
AZFb deleted
Maturation Arrest
No retrievable sperm
AZFc deleted
Hypospermatogenesis
70% chance of retrieving
testicular sperm for ICSI

Esteves, Androfert
PESA/MESATESA/TESELaboratory Sperm Processing for ICSI

PESA/MESA

Esteves, Androfert
Reproductive Potential of Azoospermic Men in ART

SpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjection
Verza Jr S & Esteves SC; IntBraz J Urol 2008; 34
Not statistically different

Esteves, Androfert
Not statistically different

Esteves, Androfert
* P<0.05

Sperm Retrieval Rates and Reproductive Potential of Azoospermic Men in ICSI
Prudencio C, Seoul B, Esteves SC. Reproductive potential of azoospermic men undergoing intracytoplasmic sperm injection is dependent on the type of azoospermia.
FertilSteril 2010; 94 (4): Suppl. S232-233.

Sperm Retrieval Techniques
Practical Points
Obstructive Azoospermia
Sperm retrieval and lab processing simple
Sperm obtained in virtually all cases
Chance of Retrieval and ICSI Outcomes:
Independent on obstruction etiology
Independent on retrieval technique
Independent on sperm source
Results similar or better than ejaculated sperm

Sperm Retrieval Techniques
Practical Points
Non-obstructive Azoospermia
Sperm production deficient or absent
Overall, retrieval rates ~50%
Labor-intensive lab sperm processing
Retrieval rates dependent on technique
Micro-TESE yields better SRR
Predictive factors: testis histology & Y-chromosome
Reproductive potential by ICSI lower than OA and non-azoospermic men

Sperm retrieval techniques

by Sandro Esteves on Aug 10, 2011

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