Reproductive Andrology Workshop III 17-21 January 2016 - Kuwait City - KUWAIT Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health Lecture 2: Chances of Harvesting Sperm in Nonobstructive Azoospermia

1.
REPRODUCTIVE ANDROLOGY SURGERY WORKSHOP III
17-21 January 2016 – Reproductive Medicine Unit – Jahra Hospital
KUWAIT
CLINICAL MANAGEMENT OF MEN WITH
NONOBSTRUCTIVE AZOOSPERMIA
Lesson 2: Chances of Harvesting Sperm
Dr Sandro ESTEVES
Medical and Scientific Director
ANDROFERT - Andrology & Human Reproduction Clinic
Campinas, Brazil

2. ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 2
2016
ANDROFERT

3. Challenges
faced
by
health
professionals
providing
care
for
men
with
SF
§ Counseling
about
the
chances
of
harves:ng
sperm
within
the
tes:cle
§ Usefulness
of
any
medical
interven:on
before
sperm
retrieval
§ Which
sperm
retrieval
method
to
apply
§ Reproduc:ve
poten:al
of
retrieved
gametes
in
ICSI
treatment
§ Health
of
offspring
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 3
2016
ANDROFERT

4. Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83
About 40-50% of men with SF have residual
spermatogenesis within the testis
§ Not enough for sperm to
appear in ejaculate
§ 600-800 seminiferous tubules
§ Goal is identify site of
production and retrieve
sperm for ICSI
§ Geographic location
unpredictable
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 4
2016
ANDROFERT

5. Esteves et al Fertil Steril 2010; Raman & Schlegel J Urol 2003;
Hopps et al. Hum Reprod 2003; Damani et al JCO 2002
Etiology category
Success in
harvesting sperm
Cryptorchidism
52-74%
Post-infection
67%
Torsion/Trauma
~50%
Post-chemotherapy/RT
25-75%
Genetic
0-70%
Idiopathic
50-60%
Etiology cannot determine whether or not
sperm will be found within the testis
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 5
2016
ANDROFERT

6. FSH levels
Testosterone
levels
Testicular
volume
elec:ng
candidates
for
SR
Can
biomarkers
predict
SR
success?
Diagnostic markers reflect global testicular
function but not the presence of a site of
active spermatogenesis
Verza Jr & Esteves. Fertil Steril 2011; 96 (Suppl.): S53
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 6
2016
ANDROFERT

7. Biopsy helpful for counseling
but does not provide definitive proof of whether sperm
will be found; may jeopardize future retrieval attempts
100%
40.3%
19.5%
Hypospermatogenesis
Maturation Arrest
Sertoli-cell only
Presence of sperm within the
testicle (N=357)
Esteves & Agarwal. Asian J Androl 2014; 16: 642
Testicular
histopathology
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 7
2016
ANDROFERT

8. Genetic assessment of AZF region within the Y
chromosome helpful to determine the chances of
finding testicular sperm
Hamada et al. Clinics 2013; 68 (Suppl 1): 39-60; Krausz et al. Andrologia 2014; 2: 5-19
Microdeletions
within AZF
region found in
up to 15% of
men with SF
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 8
2016
ANDROFERT

9. Multiplex-PCR molecular diagnosis of
YCMD
#4
Normal male
#5
AZFb microdeletion
#6
AZFc microdeletion
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 9
2016
ANDROFERT

10. ✕✕✕
nil
nil
~50%
Hamada et al. 2013; Krausz et al. 2014; Esteves et al. 2013
Complete AZFa, AZFb or AZFa+b
microdeletions unfavorable prognosis;
SR not recommended
Chances of
finding sperm
within the
testis
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 10
2016
ANDROFERT

11. Key Messages – Day 2
Chances of Harvesting Sperm
ANDROFERT
§ Diagnostic parameters not accurate to
determine if residual spermatogenesis exists
§ YCMD screening mandatory to “deselect” men
with AZFa-b deletions from SR
§ Male offspring of fathers with AZFc
microdeletions will inherit the Yq deletion
(infertility)
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 11
2016
ANDROFERT

12. Thank
you
This
presenta:on
is
available
at
hCp://www.slideshare.net/
sandroesteves
‫ا‬‫شكر‬