Clinical Outcomes using EjaculatedSperm in Cryptozoospermic MenAUA 2013 PresentationPaul J. Turek MD,Director, The Turek C...
CryptozoospermiaReliable ejaculated sperm?NoIVF-ICSIBank Ejaculated SpermYesFNA Map(1-3 mos)MicroTESE(<1 mos)Treat/Improve...
CryptozoospermiaReliable ejaculated sperm?2001-2003 UCSFN=15 men with•Severe oligospermia•Complete asthenospermiaZenke et ...
CryptozoospermiaReliable ejaculated sperm?2001-2003 UCSFN=15 men withSevere oligospermiaComplete asthenospermiaZenke et al...
Reliable ejaculated sperm?Yes2010-2012 The Turek ClinicN=40 men withcryptozoospermiaMean age=38 yearsNo spermNonmotileMoti...
Reliable ejaculated sperm?Yes2010-2012 The Turek ClinicN=34 men banking spermMean age=38 yearsHagerty et al, 2012•Mean 3.2...
Hagerty et al, 2012Reliable ejaculated sperm?NoTreat/Improve(3-6 mos)•2010-2012 The Turek Clinic•N=40 men withcryptozoospe...
CryptozoospermiaIVF-ICSI•2010-2012•N=40 men withcryptozoospermia•To date, 13/40 couples to IVF-ICSI•Sperm source:FreshEjac...
Reliable ejaculated sperm?NoFNA Map(1-3 mos)MicroTESE(<1 mos)Treat/Improve(3-6 mos)Unilateral TESA (n=3)Bilateral TESA (n=...
Testis spermaspiration(TESA)Testis spermextraction(TESE)Testismicrodissection(MicroTESE)Less Invasive More InvasiveNot all...
Sperm Sourceand ICSI Fertilization RatesNOA-Testis sperm NOA-CryptozoospermiaXXWhat kind of performance differences do we ...
Cryptozoospermia•Most men (85%) will be able to bank ejaculated sperm.•Sample to sample variability in ejaculates is high ...
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Clinical Outcomes using Ejaculated Sperm in Cryptozoospermic Men - AUA 2013 Presentation - Paul J. Turek MD, Director, The Turek Clinic San Francisco, CA

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This week, we are presenting our latest research that says no to surgery at the annual meeting of the American Urological Association—a group of surgeons, no less. For this study, we decided to avoid operating on infertile testicles and simply plan to use as much ejaculated sperm as we could get. We had infertile men freeze consecutive semen samples until sufficient sperm were available for IVF-ICSI. Couples then proceeded to IVF-ICSI using a combination of fresh and frozen-thawed ejaculated sperm. What we learned surprised even us! Read more > http://theturekclinic.com/?p=8866

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Clinical Outcomes using Ejaculated Sperm in Cryptozoospermic Men - AUA 2013 Presentation - Paul J. Turek MD, Director, The Turek Clinic San Francisco, CA

  1. 1. Clinical Outcomes using EjaculatedSperm in Cryptozoospermic MenAUA 2013 PresentationPaul J. Turek MD,Director, The Turek ClinicSan Francisco, CA
  2. 2. CryptozoospermiaReliable ejaculated sperm?NoIVF-ICSIBank Ejaculated SpermYesFNA Map(1-3 mos)MicroTESE(<1 mos)Treat/Improve(3-6 mos)Testis Testis/Ejaculate Ejaculate EjaculateThe Turek ClinicApproach
  3. 3. CryptozoospermiaReliable ejaculated sperm?2001-2003 UCSFN=15 men with•Severe oligospermia•Complete asthenospermiaZenke et al, ASRM, 2003Parameter Mean RangeTestis volume R: 15.6mL; L: 14 mL L:4-20mL; R: 6-20mLTotal Testosterone 305 ng/mL 170-450 ng/mLFSH 9.7 mIU/mL 2-16.7 mIU/mLEjaculate volume 2.7 mL 2-4.5mLSperm concentration 10 sperm to 3 million/mLMotility 0-50%
  4. 4. CryptozoospermiaReliable ejaculated sperm?2001-2003 UCSFN=15 men withSevere oligospermiaComplete asthenospermiaZenke et al, ASRM, 2003
  5. 5. Reliable ejaculated sperm?Yes2010-2012 The Turek ClinicN=40 men withcryptozoospermiaMean age=38 yearsNo spermNonmotileMotileMotile andnonmotile10%25%60%5%Hagerty et al, 2012•85% of men able tobank sperm•40% sample-to-sample variability
  6. 6. Reliable ejaculated sperm?Yes2010-2012 The Turek ClinicN=34 men banking spermMean age=38 yearsHagerty et al, 2012•Mean 3.25samplesbanked/pt•Range 1-7 ejaculates•Mean TMC banked/ejaculate=79,633motile sperm•TMC range/ejaculate:1 to 1.19 million05101520253035%PtsMean TMC/banked ejaculate
  7. 7. Hagerty et al, 2012Reliable ejaculated sperm?NoTreat/Improve(3-6 mos)•2010-2012 The Turek Clinic•N=40 men withcryptozoospermia•23/40 received therapy(57%) before banking•Among treated:3/23 (13%) varicocele20/23 (87%) medicalNo Rx Yes Rx66,00028,600Mean Banked TMC/Ejaculate
  8. 8. CryptozoospermiaIVF-ICSI•2010-2012•N=40 men withcryptozoospermia•To date, 13/40 couples to IVF-ICSI•Sperm source:FreshEjaculate77%ThawedEjaculate8%mTESE15% •Mean female age 32.4 yrs(27-41 yrs)•60% 2PN rate•46% (6/13) ongoing preg. rateHagerty et al, 2012
  9. 9. Reliable ejaculated sperm?NoFNA Map(1-3 mos)MicroTESE(<1 mos)Treat/Improve(3-6 mos)Unilateral TESA (n=3)Bilateral TESA (n=2)Bilateral TESE (n=1)Unil. Micro-TESE (n=2)2001-2003 UCSFN=15 men withSevere oligospermiaComplete asthenospermiaN=8 (61%) needed spermretrieval
  10. 10. Testis spermaspiration(TESA)Testis spermextraction(TESE)Testismicrodissection(MicroTESE)Less Invasive More InvasiveNot all sperm retrieval procedures are the same
  11. 11. Sperm Sourceand ICSI Fertilization RatesNOA-Testis sperm NOA-CryptozoospermiaXXWhat kind of performance differences do we expectBetween ejaculated and testicular sperm…none really.
  12. 12. Cryptozoospermia•Most men (85%) will be able to bank ejaculated sperm.•Sample to sample variability in ejaculates is high (40%)•Medical or surgical therapy may not improveejaculated sperm counts.•Ejaculated sperm (fresh or thawed) is available for mostmen (85%) at IVF-ICSI•IVF fertilization and pregnancy rates are reasonablewith ejaculated sperm.•Be kind to your patients (and avoid mTESE).

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