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Sperm Retrieval <br />Techniques<br />“Understanding Infertility” – New Delhi, India – August 2011<br />SandroEsteves, MD,...
Learning Objectives<br />Esteves, 2<br />
Azoospermia<br /><ul><li>It is not a synonymous of sterility </li></li></ul><li>Obstructive Azoospermia<br />Sperm retriev...
Testis
Simple and effective</li></li></ul><li>Pleasevisithttp://androfert.com.br/videostoseethevideo<br />
PERCUTANEOUS RETRIEVAL <br />Esteves SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and intracy...
Non-obstructive Azoospermia<br />Untreatable condition<br />Sperm Retrieval for ART<br /><ul><li>Sperm production reduced ...
Geographic location unpredictable</li></ul>TESA<br />TESE<br />
Non-obstructive AzoospermiaTesticular Sperm Aspiration - TESA<br />
Non-obstructive AzoospermiaTesticular microdissection - micro-TESE<br /><ul><li>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</li></ul>Schlegel, Hum Reprod 1999; 14<br />
Pleasevisithttp://androfert.com.br/videostoseethevideo<br />
Esteves, Androfert<br />Sperm Retrieval Rates in NOA are Related to Testicular Histopathology but not to the Etiology of A...
 Microdissection TESE or TESA
 Classified according to the Etiology of NOA
 Biopsy for histology concomitant or prior to SR</li></ul>Hypospermatogenesis (HYPO)<br />Maturation Arrest (MA)<br />Sert...
SpermRetrievalandEtiologyof NOA<br />Etiology<br />Chi-square; NS<br />Esteves SC, Verza S, Prudencio C, Seol B. Sperm ret...
Esteves, Androfert<br />SpermRetrieval in NOA isrelatedto<br />Testicular Histopathology<br />Esteves SC et al FertilSteri...
Micro-TESE<br />39%<br />P=.03<br />Micro-TESE<br />TESA/TESE<br />N=131; *hypospermatogenesis excluded<br />Esteveset al....
Esteves, Androfert<br />Predictive Factors for Sperm Retrieval in NOA<br />Chance of finding sperm is dependent on the mos...
Predictive Factors for Sperm Retrieval in NOAY Chromosome Microdeletion<br />AZFa deleted<br />Germ cell Aplasia<br />No r...
Esteves, Androfert<br />PESA/MESATESA/TESELaboratory Sperm Processing for ICSI<br />
PESA/MESA<br />
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Sperm retrieval techniques

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“Understanding Infertility”: A CME Course in Reproductive Medicine
August 12-14th, 2011 New Delhi, India

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Transcript of "Sperm retrieval techniques"

  1. 1. Sperm Retrieval <br />Techniques<br />“Understanding Infertility” – New Delhi, India – August 2011<br />SandroEsteves, MD, PhD<br />Director, ANDROFERT<br />Center for Male Reproduction and Infertility<br />Campinas, BRAZIL<br />Esteves, 1<br />
  2. 2. Learning Objectives<br />Esteves, 2<br />
  3. 3. Azoospermia<br /><ul><li>It is not a synonymous of sterility </li></li></ul><li>Obstructive Azoospermia<br />Sperm retrieval for ART<br /><ul><li>Epididymis
  4. 4. Testis
  5. 5. Simple and effective</li></li></ul><li>Pleasevisithttp://androfert.com.br/videostoseethevideo<br />
  6. 6. PERCUTANEOUS RETRIEVAL <br />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.<br />
  7. 7. Non-obstructive Azoospermia<br />Untreatable condition<br />Sperm Retrieval for ART<br /><ul><li>Sperm production reduced or absent
  8. 8. Geographic location unpredictable</li></ul>TESA<br />TESE<br />
  9. 9. Non-obstructive AzoospermiaTesticular Sperm Aspiration - TESA<br />
  10. 10. Non-obstructive AzoospermiaTesticular microdissection - micro-TESE<br /><ul><li>Method to identify site(s) of production
  11. 11. Based on the diameter of seminiferous tubules
  12. 12. Microsurgical approach
  13. 13. Identify site of production
  14. 14. Preserve vasculature of testis
  15. 15. Small quantity of tissue excised</li></ul>Schlegel, Hum Reprod 1999; 14<br />
  16. 16. Pleasevisithttp://androfert.com.br/videostoseethevideo<br />
  17. 17. Esteves, Androfert<br />Sperm Retrieval Rates in NOA are Related to Testicular Histopathology but not to the Etiology of Azoospermia<br />Esteves SC, Verza Jr S, Prudencio C, Seol B; FertilSteril 2010<br /><ul><li> 176 NOA men (mean age 36.9 years)
  18. 18. Microdissection TESE or TESA
  19. 19. Classified according to the Etiology of NOA
  20. 20. Biopsy for histology concomitant or prior to SR</li></ul>Hypospermatogenesis (HYPO)<br />Maturation Arrest (MA)<br />Sertoli Cell Only Syndrome (SCO)<br />
  21. 21. SpermRetrievalandEtiologyof NOA<br />Etiology<br />Chi-square; NS<br />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.<br />
  22. 22. Esteves, Androfert<br />SpermRetrieval in NOA isrelatedto<br />Testicular Histopathology<br />Esteves SC et al FertilSteril 2010; 94:S132<br />Results (2): Micro-TESE X TESA<br />*TESA vs micro-TESE (MA + SCO): P=.03<br />
  23. 23. Micro-TESE<br />39%<br />P=.03<br />Micro-TESE<br />TESA/TESE<br />N=131; *hypospermatogenesis excluded<br />Esteveset al.; FertilSteril 2010; 94:S132<br />
  24. 24. Esteves, Androfert<br />Predictive Factors for Sperm Retrieval in NOA<br />Chance of finding sperm is dependent on the most advanced site of spermatogenesis within the testis<br />FSH<br />InhibinB<br />Testicular volume<br />Etiology<br />Testosterone levels<br />Testis histology <br />Reflect global spermatogenic function but not the most advanced site of sperm production in a dysfunctional testis<br />
  25. 25. Predictive Factors for Sperm Retrieval in NOAY Chromosome Microdeletion<br />AZFa deleted<br />Germ cell Aplasia<br />No retrievable sperm<br />AZFb deleted<br />Maturation Arrest <br />No retrievable sperm<br />AZFc deleted<br />Hypospermatogenesis<br />70% chance of retrieving <br />testicular sperm for ICSI<br />
  26. 26. Esteves, Androfert<br />PESA/MESATESA/TESELaboratory Sperm Processing for ICSI<br />
  27. 27. PESA/MESA<br />
  28. 28. TESA<br />
  29. 29. TESE<br />
  30. 30. Esteves, Androfert<br />Reproductive Potential of Azoospermic Men in ART<br />
  31. 31. SpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjection<br />Verza Jr S & Esteves SC; IntBraz J Urol 2008; 34<br />Not statistically different<br />
  32. 32. Esteves, Androfert<br />SpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjection<br />Verza Jr S & Esteves SC; IntBraz J Urol 2008; 34<br />Not statistically different<br />
  33. 33. Esteves, Androfert<br />SpermDefectSeverityRatherThanSpermSourceIs Associated WithLowerFertilization Rates AfterIntracytoplasmicSpermInjection<br />Verza Jr S & Esteves SC; IntBraz J Urol 2008; 34<br />* P<0.05<br />
  34. 34. Sperm Retrieval Rates and Reproductive Potential of Azoospermic Men in ICSI<br />Prudencio C, Seoul B, Esteves SC. Reproductive potential of azoospermic men undergoing intracytoplasmic sperm injection is dependent on the type of azoospermia.<br />FertilSteril 2010; 94 (4): Suppl. S232-233.<br />
  35. 35. Sperm Retrieval Techniques<br />Practical Points<br />Obstructive Azoospermia<br /><ul><li>Sperm retrieval and lab processing simple
  36. 36. Sperm obtained in virtually all cases
  37. 37. Chance of Retrieval and ICSI Outcomes:
  38. 38. Independent on obstruction etiology
  39. 39. Independent on retrieval technique
  40. 40. Independent on sperm source
  41. 41. Results similar or better than ejaculated sperm</li></li></ul><li>Sperm Retrieval Techniques<br />Practical Points<br />Non-obstructive Azoospermia<br /><ul><li>Sperm production deficient or absent
  42. 42. Overall, retrieval rates ~50%
  43. 43. Labor-intensive lab sperm processing
  44. 44. Retrieval rates dependent on technique
  45. 45. Micro-TESE yields better SRR
  46. 46. Predictive factors: testis histology & Y-chromosome
  47. 47. Reproductive potential by ICSI lower than OA and non-azoospermic men </li>
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