1. The document discusses sperm retrieval techniques for azoospermic men seeking fertility.
2. The optimal sperm retrieval method depends on whether the azoospermia is obstructive or non-obstructive.
3. Microsurgical testicular sperm extraction (micro-TESE) has higher success rates than conventional testicular sperm extraction for non-obstructive azoospermia, especially for men with more severe testicular failure.
This document discusses various surgical sperm retrieval techniques for assisted reproduction, including:
1) Percutaneous epididymal sperm aspiration (PESA) and microsurgical epididymal sperm aspiration (MESA) are used to retrieve sperm from the epididymis in cases of obstructive azoospermia.
2) Testicular sperm aspiration (TESA) and testicular sperm extraction (TESE) are used to retrieve sperm directly from the testes in cases of non-obstructive azoospermia or previous failed epididymal sperm retrieval.
3) Microsurgical testicular sperm extraction (Micro-TESE) uses an operating microscope to identify and extract semin
This document provides an overview of sperm retrieval techniques for non-obstructive azoospermia (NOA). It discusses that sperm retrieval rates are related to testicular histopathology, not etiology of azoospermia. Microdissection TESE has higher sperm retrieval rates than standard TESE, especially for men with maturation arrest or Sertoli cell only syndrome. The chances of sperm retrieval and live birth through ICSI are dependent on the type of azoospermia, with higher success rates for obstructive versus non-obstructive causes.
Sperm retrieval techniques - nuts and boltsSandro Esteves
This document summarizes a training program in assisted reproductive technology focusing on azoospermia. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval techniques such as PESA, MESA, TESA, and TESE. Success rates of sperm retrieval are provided for different causes of azoospermia. Predictive markers for sperm retrieval success are also examined, such as hormone levels, testicular volume, histopathology, and microdeletions. Micro-TESE is highlighted as a promising surgical method for non-obstructive azoospermia.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in India and abroad. He lists his qualifications and areas of practice. The document then discusses limitations of the 2010 WHO semen analysis guidelines, significance of sperm DNA fragmentation testing, definitions of mild and severe male factor infertility, and investigations and treatment approaches for various causes of male infertility including varicocele, congenital bilateral absence of vas deferens, cryptorchidism, hormonal abnormalities, and azoospermia. Key advice includes thorough evaluation and evidence-based therapies over long-term use of unproven drugs, and considering sperm retrieval and assisted reproduction rather than assuming donor sperm is the only option.
Micro-TESE as the latest option for the worst azoospermia scenariosSandro Esteves
This document summarizes information from a presentation on azoospermia and microsurgical testicular sperm extraction (Micro-TESE). It defines obstructive and non-obstructive azoospermia and compares conventional sperm retrieval techniques to Micro-TESE. Micro-TESE has higher sperm retrieval rates compared to conventional TESE, especially for men with non-obstructive azoospermia. It allows identification and preservation of the few seminiferous tubules that may contain sperm, minimizing damage to the testis.
Surgical Techniques in Male Factor InfertilitySandro Esteves
The document outlines surgical techniques for treating male infertility including varicocelectomy, sperm retrieval, vasovasostomy, and vasoepididymostomy. It discusses the indications and outcomes of microsurgical varicocelectomy and reviews studies showing it can improve sperm parameters, fertility with ICSI, and spontaneous pregnancy rates. The success rates of different surgical reconstruction techniques for vasal and epididymal obstructions are presented. Transurethral resection of ejaculatory ducts is described as a treatment for ejaculatory duct obstruction that can improve semen quality and fertility.
Iran march 2011
ABRASCT:
SPERM RETRIEVAL TECHNIQUES FOR THE AZOOSPERMIC MALE
Sandro C. Esteves, MD, PhD
Spermatozoa can be retrieved from either the epididymis or the testis, depending on the type of azoospermia, using different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE.
In obstructive azoospermia (OA), sperm production is normal and gametes can be easily retrieved from the epididymis or the testicle in most cases, irrespective of the technique. PESA or TESA are simple and efficient methods for retrieving epididymal or testicular spermatozoa in men with OA. According to our data on OA, the etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates.
In cases of nonobstructive azoospermia (NOA), the efficiency of TESA for retrieving spermatozoa is lower than TESE, except in the favorable cases of men with previous successful TESA or testicular histopathology showing hypospermatogenesis. The use of microsurgery during TESE may improve the efficacy of sperm extraction with significantly less tissue removed, which ultimately facilitates sperm processing. Testicular histology results, if available, may be useful to predict the chances to retrieve sperm in men with NOA. Our data demonstrate that micro-TESE performs better than conventional TESE or TESA in cases of maturation arrest and Sertoli cell-only histological patterns, where tubules containing active focus of spermatogenesis can be positively identified using microsurgery. Testicular spermatozoa can be obtained even in the worst case scenario except in the cases of Y chromosome infertility with complete AZFa and/or AZFbmicrodeletions.
In both OA and NOA, sperm retrieval technique itself seems to have no impact on ICSI success rates. The main goal of PESA/TESA/TESE sperm processing is the recovery of a clean sample containing motile sperm. Such specimens are more fragile, and often compromised in motility, as compared to the ones obtained from ejaculates. Laboratory techniques should be carried out with great caution not to jeopardize the sperm fertilizing potential. Surgically-retrieved spermatozoa can be intentionally cryopreserved for future use. Spare left-over specimens that would be discharged after ICSI can also be cryostored. Different strategies can be developed according to each group’s results. If freezing of surgically-retrieved specimens provides results similar to those with the use of fresh sperm, then the use of freezing specimens would be preferable. If not, fresh specimens are preferable.
The reproductive potential of infertile men undergoing ART is related to the type of azoospermia. According to our data, the chances of retrieving spermatozoa (odds ratio [OR] = 43.0; 95% confidence interval [CI]: 10.3-179.5) and of achieving a live birth by ICSI (OR=1.86; 95% CI:l 1.03-2.89) were significantly increased in couples whose male partner had obstructive rather than non-obstructive azoospermia. Children conceived using sperm retrieved from men with OA and NOA should be followed-up because it is still unclear if there is an increased risk of birth defects when ICSI is carried out with non-ejaculated sperm.
References
Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. IntBraz J Urol. 2005; 31:541-8.
Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. IntBraz J Urol. 2008,34:49-56.
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 SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and i
This document discusses various surgical sperm retrieval techniques for assisted reproduction, including:
1) Percutaneous epididymal sperm aspiration (PESA) and microsurgical epididymal sperm aspiration (MESA) are used to retrieve sperm from the epididymis in cases of obstructive azoospermia.
2) Testicular sperm aspiration (TESA) and testicular sperm extraction (TESE) are used to retrieve sperm directly from the testes in cases of non-obstructive azoospermia or previous failed epididymal sperm retrieval.
3) Microsurgical testicular sperm extraction (Micro-TESE) uses an operating microscope to identify and extract semin
This document provides an overview of sperm retrieval techniques for non-obstructive azoospermia (NOA). It discusses that sperm retrieval rates are related to testicular histopathology, not etiology of azoospermia. Microdissection TESE has higher sperm retrieval rates than standard TESE, especially for men with maturation arrest or Sertoli cell only syndrome. The chances of sperm retrieval and live birth through ICSI are dependent on the type of azoospermia, with higher success rates for obstructive versus non-obstructive causes.
Sperm retrieval techniques - nuts and boltsSandro Esteves
This document summarizes a training program in assisted reproductive technology focusing on azoospermia. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval techniques such as PESA, MESA, TESA, and TESE. Success rates of sperm retrieval are provided for different causes of azoospermia. Predictive markers for sperm retrieval success are also examined, such as hormone levels, testicular volume, histopathology, and microdeletions. Micro-TESE is highlighted as a promising surgical method for non-obstructive azoospermia.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in India and abroad. He lists his qualifications and areas of practice. The document then discusses limitations of the 2010 WHO semen analysis guidelines, significance of sperm DNA fragmentation testing, definitions of mild and severe male factor infertility, and investigations and treatment approaches for various causes of male infertility including varicocele, congenital bilateral absence of vas deferens, cryptorchidism, hormonal abnormalities, and azoospermia. Key advice includes thorough evaluation and evidence-based therapies over long-term use of unproven drugs, and considering sperm retrieval and assisted reproduction rather than assuming donor sperm is the only option.
Micro-TESE as the latest option for the worst azoospermia scenariosSandro Esteves
This document summarizes information from a presentation on azoospermia and microsurgical testicular sperm extraction (Micro-TESE). It defines obstructive and non-obstructive azoospermia and compares conventional sperm retrieval techniques to Micro-TESE. Micro-TESE has higher sperm retrieval rates compared to conventional TESE, especially for men with non-obstructive azoospermia. It allows identification and preservation of the few seminiferous tubules that may contain sperm, minimizing damage to the testis.
Surgical Techniques in Male Factor InfertilitySandro Esteves
The document outlines surgical techniques for treating male infertility including varicocelectomy, sperm retrieval, vasovasostomy, and vasoepididymostomy. It discusses the indications and outcomes of microsurgical varicocelectomy and reviews studies showing it can improve sperm parameters, fertility with ICSI, and spontaneous pregnancy rates. The success rates of different surgical reconstruction techniques for vasal and epididymal obstructions are presented. Transurethral resection of ejaculatory ducts is described as a treatment for ejaculatory duct obstruction that can improve semen quality and fertility.
Iran march 2011
ABRASCT:
SPERM RETRIEVAL TECHNIQUES FOR THE AZOOSPERMIC MALE
Sandro C. Esteves, MD, PhD
Spermatozoa can be retrieved from either the epididymis or the testis, depending on the type of azoospermia, using different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE.
In obstructive azoospermia (OA), sperm production is normal and gametes can be easily retrieved from the epididymis or the testicle in most cases, irrespective of the technique. PESA or TESA are simple and efficient methods for retrieving epididymal or testicular spermatozoa in men with OA. According to our data on OA, the etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates.
In cases of nonobstructive azoospermia (NOA), the efficiency of TESA for retrieving spermatozoa is lower than TESE, except in the favorable cases of men with previous successful TESA or testicular histopathology showing hypospermatogenesis. The use of microsurgery during TESE may improve the efficacy of sperm extraction with significantly less tissue removed, which ultimately facilitates sperm processing. Testicular histology results, if available, may be useful to predict the chances to retrieve sperm in men with NOA. Our data demonstrate that micro-TESE performs better than conventional TESE or TESA in cases of maturation arrest and Sertoli cell-only histological patterns, where tubules containing active focus of spermatogenesis can be positively identified using microsurgery. Testicular spermatozoa can be obtained even in the worst case scenario except in the cases of Y chromosome infertility with complete AZFa and/or AZFbmicrodeletions.
In both OA and NOA, sperm retrieval technique itself seems to have no impact on ICSI success rates. The main goal of PESA/TESA/TESE sperm processing is the recovery of a clean sample containing motile sperm. Such specimens are more fragile, and often compromised in motility, as compared to the ones obtained from ejaculates. Laboratory techniques should be carried out with great caution not to jeopardize the sperm fertilizing potential. Surgically-retrieved spermatozoa can be intentionally cryopreserved for future use. Spare left-over specimens that would be discharged after ICSI can also be cryostored. Different strategies can be developed according to each group’s results. If freezing of surgically-retrieved specimens provides results similar to those with the use of fresh sperm, then the use of freezing specimens would be preferable. If not, fresh specimens are preferable.
The reproductive potential of infertile men undergoing ART is related to the type of azoospermia. According to our data, the chances of retrieving spermatozoa (odds ratio [OR] = 43.0; 95% confidence interval [CI]: 10.3-179.5) and of achieving a live birth by ICSI (OR=1.86; 95% CI:l 1.03-2.89) were significantly increased in couples whose male partner had obstructive rather than non-obstructive azoospermia. Children conceived using sperm retrieved from men with OA and NOA should be followed-up because it is still unclear if there is an increased risk of birth defects when ICSI is carried out with non-ejaculated sperm.
References
Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. IntBraz J Urol. 2005; 31:541-8.
Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. IntBraz J Urol. 2008,34:49-56.
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 SC, Verza S, Prudencio C, Seol B. Success of percutaneous sperm retrieval and i
This document discusses and compares different sperm retrieval techniques for assisted reproduction, including MESA (microscopic epididymal sperm aspiration), TESE (testicular sperm extraction), and Micro-TESE. It provides details on the techniques, including their effectiveness, efficiency, costs, complexity, and complication rates. For non-obstructive azoospermia, Micro-TESE has higher sperm retrieval rates of 40-67% compared to 20-60% for conventional TESE. Micro-TESE also retrieves less tissue on average but has higher fertilization and live birth rates. The document emphasizes Micro-TESE as the preferred technique for non-obstructive azoospermia cases.
Clinical Utility of Sperm DNA Fragmentation Testing in Male Infertility Treat...Sandro Esteves
1) Sperm DNA fragmentation (SDF) testing provides important information about male fertility beyond conventional semen analysis.
2) Higher levels of SDF are associated with lower rates of pregnancy and live birth with infertility treatments like IUI and IVF/ICSI. It can also increase the risk of miscarriage.
3) Validated tests for SDF include the sperm chromatin dispersion test and TUNEL assay. Research is ongoing to improve testing methods and interpretation of results to help guide patient care.
This document summarizes sperm retrieval techniques for treating obstructive and non-obstructive azoospermia. It discusses Percutaneous Epididymal Sperm Aspiration (PESA), Microsurgical Epididymal Sperm Aspiration (MESA), Testicular Sperm Aspiration (TESA), and Micro-TESE. It provides success rates for these techniques in different conditions and finds Micro-TESE more effective than conventional TESE for non-obstructive azoospermia. The document also includes links to video demonstrations of MESA and Micro-TESE procedures.
This document provides an overview of the clinical management of nonobstructive azoospermia (NOA). It begins by defining NOA and explaining its challenges. It then discusses the diagnostic evaluation and differentiates between obstructive and nonobstructive causes. For NOA due to spermatogenic failure, the document outlines that the condition is irreversible and reviews sperm retrieval techniques and their success rates depending on the underlying etiology. It also notes that while biomarkers can reflect testicular function, they cannot definitively predict whether sperm will be found for retrieval.
The document discusses modern trends in the management of azoospermia. It begins by defining azoospermia and discussing prevalence. It then covers evaluation of azoospermia including history, physical exam, hormonal assessment, imaging, and genetic testing to determine if the cause is obstructive or non-obstructive. For non-obstructive cases, pretreatment with gonadotropins may help. Surgical sperm retrieval techniques are discussed including micro-TESE which has a 50% success rate. Varicocele repair in non-obstructive azoospermia is also reviewed. The summary emphasizes improved evaluation and management options have increased treatment success rates for many azoospermic men.
The document outlines the key considerations for setting up an ART lab, including location, equipment, consumables, procedures, and quality control. The lab must be in a safe, pathogen-free environment with stable temperature and air quality. Critical equipment includes incubators, laminar flow hoods, micromanipulators, medical refrigerators, and liquid nitrogen tanks. Consumables must be established brands and not expired. Procedures must be documented and strictly followed. Quality control such as temperature monitoring is crucial.
This document provides information about azoospermia, including definitions, types, causes, and sperm retrieval techniques. It defines azoospermia as the absence of sperm in the ejaculate. There are two main types - obstructive azoospermia, which is due to blockages, and non-obstructive azoospermia, which is due to testicular failure. Various sperm retrieval techniques are described that can be used depending on the type of azoospermia, including microsurgical epididymal sperm aspiration, percutaneous epididymal sperm aspiration, and testicular sperm extraction. Complications of the procedures include hematoma, infection, and testicular fibrosis.
This document summarizes medical management strategies for male infertility. It discusses empirical and hormonal treatments for different types of male infertility, including hypogonadism. Specific treatments are recommended based on hormone levels and categories of infertility. For example, men with hypo-hypo infertility may benefit from recombinant hCG treatment. Aromatase inhibitors are discussed as a treatment for obesity-related infertility to reduce elevated estradiol levels. The document also covers potential benefits of medical therapy prior to sperm retrieval procedures for patients with non-obstructive azoospermia.
Management of thin endometrium isar 2019Poonam Loomba
This document discusses strategies for managing a thin endometrium. It begins by providing background on endometrial anatomy and physiology. It then discusses the rise of assisted reproductive technology (ART) in India. Common causes of a thin endometrium are described, including iatrogenic injuries, infections, low estrogen levels, and inadequate blood flow. A variety of treatment strategies are discussed, such as hormonal adjustments, medications like pentoxifylline and tocopherol, acupuncture, L-arginine, and more recently investigated options like vaginal sildenafil, granulocyte colony-stimulating factor, and endometrial scratch. Specific studies investigating treatments like extended estrogen administration, tamox
The document outlines the key procedures involved in ICSI lab work for a gynecologist, as presented by Aboubakr Elnashar from Benha University in Egypt. It discusses 8 main procedures: 1) semen preparation, 2) oocyte identification, 3) oocyte denudation, 4) oocyte assessment, 5) oocyte injection, 6) embryo selection, 7) embryo transfer, and 8) cryopreservation. For each procedure, it provides details on the aim, methods, and considerations. The document serves as a reference for best practices in ICSI lab work to optimize outcomes.
Azoospermia is an challenging subject either on the diagnostic side or on the therapeutic issues. Types of testicular biopsy must be employed in selected patients as regard their background diagnosis e.g. obstructive, Klinefelter's,... etc.
Clinical management of infertile men with nonobstructive azoospermia: current...Sandro Esteves
This document summarizes a presentation on the clinical management of men with nonobstructive azoospermia (NOA). It discusses how NOA is one of the most challenging conditions in infertility care. For men diagnosed with NOA, tests are conducted to determine if the cause is hypogonadotropic hypogonadism or spermatogenic failure. For spermatogenic failure, sperm retrieval techniques may be used but success rates vary depending on the underlying cause. Interventions like varicocele repair before sperm retrieval may improve chances of finding sperm. The document emphasizes that biomarkers cannot definitively predict sperm retrieval outcomes for men with NOA due to spermatogenic failure.
This document provides guidance on preparing patients for IVF. It discusses counseling patients, evaluating them through history, exams, screening tests, and managing associated conditions. Key points include screening both partners for infections, evaluating ovarian reserve with tests like AMH, addressing lifestyle factors and medical issues like obesity, diabetes and endometriosis, and providing preventive treatments like antibiotics and aspirin before IVF. The goal is to optimize the patient's physical and emotional health prior to starting IVF treatment.
This document discusses intracytoplasmic morphologically selected sperm injection (IMSI), a technique that uses higher magnification than conventional ICSI to select sperm for fertilization. It provides background on sperm morphology and vacuoles, and their relationship to fertility outcomes. Studies comparing IMSI to ICSI are summarized, finding improved outcomes with IMSI, especially in cases of poor semen quality or previous ICSI failure. Guidelines for when IMSI may be beneficial over conventional ICSI are presented.
Endometrial receptivity assay, by Dr.Gayathiri Morris Jawahar
The accuracy and reproducibility of the endometrial receptivity array (ERA) is superior to histology as a diagnostic method for endometrial receptivity. An study of 86 healthy ovum donors found that ERA dating showed near perfect concordance with LH peak levels, whereas histology dating showed only moderate concordance between two pathologists. The ERA test was also found to be 100% reproducible when repeated in the same patients 29-40 months later, demonstrating it is a more accurate and reproducible method for assessing endometrial receptivity compared to standard histology.
Sperm DNA Fragmentation (Oxidative stress, DNA damage and apoptosis, Test, Techniques, Relation to other semen parameters, Relationship to leucocytes, Relation to ICSI outcomes, Clinical applications, significance and limitations)
Optimize oocyte yield to maximize live birth in ARTSandro Esteves
This document discusses strategies for optimizing ovarian response in ART to maximize live birth rates. It introduces the POSEIDON criteria for stratifying "low prognosis" ART patients based on age, ovarian reserve markers, and number of oocytes retrieved. The target is to retrieve over 15 oocytes to maximize cumulative live birth rates. Personalized gonadotropin protocols and adjuvant therapies can be used to optimize response based on POSEIDON stratification. This includes starting dose, supplementation with LH, and dual stimulation if needed to obtain the estimated number of oocytes for at least one euploid embryo transfer.
1. Cancer and its treatments can impact patient sexuality through biological, physical, and psychosocial factors like changes to the body, fertility issues, and emotional distress.
2. Nurses should conduct comprehensive assessments of patient sexuality through open communication, addressing cultural and personal factors, and utilizing models like PLISSIT.
3. Nurses can manage side effects on sexuality through treating symptoms, educating on intimacy options, and referring patients to supportive resources for physical and emotional wellbeing.
4. Nurses must overcome barriers like embarrassment through active listening, normalizing issues as treatable side effects, and focusing on holistic care of the patient's wellness.
Néma tanúk vallomása a rák történetéről
Molnár Erika - Szegedi Egyetem, Embertani Tanszék
A rákos megbetegedések napjainkban világszerte a vezető haláloki tényezők közt szerepelnek, de máig vitatott, hogy kizárólag a modern kor emberét sújtó vagy a megelőző történeti korokban is pusztító kórról van-e szó.
Erre a kérdésre keressük a választ a régészet, a paleopatológia és a modern orvostudomány vizsgálati eszközeinek segítségével. A régészek által feltárt csontvázleleteken megfigyelhető kóros elváltozások néma tanúkként vallanak a rosszindulatú daganatok jelenlétéről az egykor élt emberek körében.
Budapest Science Meetup, 2014. szeptember 11.
This document discusses and compares different sperm retrieval techniques for assisted reproduction, including MESA (microscopic epididymal sperm aspiration), TESE (testicular sperm extraction), and Micro-TESE. It provides details on the techniques, including their effectiveness, efficiency, costs, complexity, and complication rates. For non-obstructive azoospermia, Micro-TESE has higher sperm retrieval rates of 40-67% compared to 20-60% for conventional TESE. Micro-TESE also retrieves less tissue on average but has higher fertilization and live birth rates. The document emphasizes Micro-TESE as the preferred technique for non-obstructive azoospermia cases.
Clinical Utility of Sperm DNA Fragmentation Testing in Male Infertility Treat...Sandro Esteves
1) Sperm DNA fragmentation (SDF) testing provides important information about male fertility beyond conventional semen analysis.
2) Higher levels of SDF are associated with lower rates of pregnancy and live birth with infertility treatments like IUI and IVF/ICSI. It can also increase the risk of miscarriage.
3) Validated tests for SDF include the sperm chromatin dispersion test and TUNEL assay. Research is ongoing to improve testing methods and interpretation of results to help guide patient care.
This document summarizes sperm retrieval techniques for treating obstructive and non-obstructive azoospermia. It discusses Percutaneous Epididymal Sperm Aspiration (PESA), Microsurgical Epididymal Sperm Aspiration (MESA), Testicular Sperm Aspiration (TESA), and Micro-TESE. It provides success rates for these techniques in different conditions and finds Micro-TESE more effective than conventional TESE for non-obstructive azoospermia. The document also includes links to video demonstrations of MESA and Micro-TESE procedures.
This document provides an overview of the clinical management of nonobstructive azoospermia (NOA). It begins by defining NOA and explaining its challenges. It then discusses the diagnostic evaluation and differentiates between obstructive and nonobstructive causes. For NOA due to spermatogenic failure, the document outlines that the condition is irreversible and reviews sperm retrieval techniques and their success rates depending on the underlying etiology. It also notes that while biomarkers can reflect testicular function, they cannot definitively predict whether sperm will be found for retrieval.
The document discusses modern trends in the management of azoospermia. It begins by defining azoospermia and discussing prevalence. It then covers evaluation of azoospermia including history, physical exam, hormonal assessment, imaging, and genetic testing to determine if the cause is obstructive or non-obstructive. For non-obstructive cases, pretreatment with gonadotropins may help. Surgical sperm retrieval techniques are discussed including micro-TESE which has a 50% success rate. Varicocele repair in non-obstructive azoospermia is also reviewed. The summary emphasizes improved evaluation and management options have increased treatment success rates for many azoospermic men.
The document outlines the key considerations for setting up an ART lab, including location, equipment, consumables, procedures, and quality control. The lab must be in a safe, pathogen-free environment with stable temperature and air quality. Critical equipment includes incubators, laminar flow hoods, micromanipulators, medical refrigerators, and liquid nitrogen tanks. Consumables must be established brands and not expired. Procedures must be documented and strictly followed. Quality control such as temperature monitoring is crucial.
This document provides information about azoospermia, including definitions, types, causes, and sperm retrieval techniques. It defines azoospermia as the absence of sperm in the ejaculate. There are two main types - obstructive azoospermia, which is due to blockages, and non-obstructive azoospermia, which is due to testicular failure. Various sperm retrieval techniques are described that can be used depending on the type of azoospermia, including microsurgical epididymal sperm aspiration, percutaneous epididymal sperm aspiration, and testicular sperm extraction. Complications of the procedures include hematoma, infection, and testicular fibrosis.
This document summarizes medical management strategies for male infertility. It discusses empirical and hormonal treatments for different types of male infertility, including hypogonadism. Specific treatments are recommended based on hormone levels and categories of infertility. For example, men with hypo-hypo infertility may benefit from recombinant hCG treatment. Aromatase inhibitors are discussed as a treatment for obesity-related infertility to reduce elevated estradiol levels. The document also covers potential benefits of medical therapy prior to sperm retrieval procedures for patients with non-obstructive azoospermia.
Management of thin endometrium isar 2019Poonam Loomba
This document discusses strategies for managing a thin endometrium. It begins by providing background on endometrial anatomy and physiology. It then discusses the rise of assisted reproductive technology (ART) in India. Common causes of a thin endometrium are described, including iatrogenic injuries, infections, low estrogen levels, and inadequate blood flow. A variety of treatment strategies are discussed, such as hormonal adjustments, medications like pentoxifylline and tocopherol, acupuncture, L-arginine, and more recently investigated options like vaginal sildenafil, granulocyte colony-stimulating factor, and endometrial scratch. Specific studies investigating treatments like extended estrogen administration, tamox
The document outlines the key procedures involved in ICSI lab work for a gynecologist, as presented by Aboubakr Elnashar from Benha University in Egypt. It discusses 8 main procedures: 1) semen preparation, 2) oocyte identification, 3) oocyte denudation, 4) oocyte assessment, 5) oocyte injection, 6) embryo selection, 7) embryo transfer, and 8) cryopreservation. For each procedure, it provides details on the aim, methods, and considerations. The document serves as a reference for best practices in ICSI lab work to optimize outcomes.
Azoospermia is an challenging subject either on the diagnostic side or on the therapeutic issues. Types of testicular biopsy must be employed in selected patients as regard their background diagnosis e.g. obstructive, Klinefelter's,... etc.
Clinical management of infertile men with nonobstructive azoospermia: current...Sandro Esteves
This document summarizes a presentation on the clinical management of men with nonobstructive azoospermia (NOA). It discusses how NOA is one of the most challenging conditions in infertility care. For men diagnosed with NOA, tests are conducted to determine if the cause is hypogonadotropic hypogonadism or spermatogenic failure. For spermatogenic failure, sperm retrieval techniques may be used but success rates vary depending on the underlying cause. Interventions like varicocele repair before sperm retrieval may improve chances of finding sperm. The document emphasizes that biomarkers cannot definitively predict sperm retrieval outcomes for men with NOA due to spermatogenic failure.
This document provides guidance on preparing patients for IVF. It discusses counseling patients, evaluating them through history, exams, screening tests, and managing associated conditions. Key points include screening both partners for infections, evaluating ovarian reserve with tests like AMH, addressing lifestyle factors and medical issues like obesity, diabetes and endometriosis, and providing preventive treatments like antibiotics and aspirin before IVF. The goal is to optimize the patient's physical and emotional health prior to starting IVF treatment.
This document discusses intracytoplasmic morphologically selected sperm injection (IMSI), a technique that uses higher magnification than conventional ICSI to select sperm for fertilization. It provides background on sperm morphology and vacuoles, and their relationship to fertility outcomes. Studies comparing IMSI to ICSI are summarized, finding improved outcomes with IMSI, especially in cases of poor semen quality or previous ICSI failure. Guidelines for when IMSI may be beneficial over conventional ICSI are presented.
Endometrial receptivity assay, by Dr.Gayathiri Morris Jawahar
The accuracy and reproducibility of the endometrial receptivity array (ERA) is superior to histology as a diagnostic method for endometrial receptivity. An study of 86 healthy ovum donors found that ERA dating showed near perfect concordance with LH peak levels, whereas histology dating showed only moderate concordance between two pathologists. The ERA test was also found to be 100% reproducible when repeated in the same patients 29-40 months later, demonstrating it is a more accurate and reproducible method for assessing endometrial receptivity compared to standard histology.
Sperm DNA Fragmentation (Oxidative stress, DNA damage and apoptosis, Test, Techniques, Relation to other semen parameters, Relationship to leucocytes, Relation to ICSI outcomes, Clinical applications, significance and limitations)
Optimize oocyte yield to maximize live birth in ARTSandro Esteves
This document discusses strategies for optimizing ovarian response in ART to maximize live birth rates. It introduces the POSEIDON criteria for stratifying "low prognosis" ART patients based on age, ovarian reserve markers, and number of oocytes retrieved. The target is to retrieve over 15 oocytes to maximize cumulative live birth rates. Personalized gonadotropin protocols and adjuvant therapies can be used to optimize response based on POSEIDON stratification. This includes starting dose, supplementation with LH, and dual stimulation if needed to obtain the estimated number of oocytes for at least one euploid embryo transfer.
1. Cancer and its treatments can impact patient sexuality through biological, physical, and psychosocial factors like changes to the body, fertility issues, and emotional distress.
2. Nurses should conduct comprehensive assessments of patient sexuality through open communication, addressing cultural and personal factors, and utilizing models like PLISSIT.
3. Nurses can manage side effects on sexuality through treating symptoms, educating on intimacy options, and referring patients to supportive resources for physical and emotional wellbeing.
4. Nurses must overcome barriers like embarrassment through active listening, normalizing issues as treatable side effects, and focusing on holistic care of the patient's wellness.
Néma tanúk vallomása a rák történetéről
Molnár Erika - Szegedi Egyetem, Embertani Tanszék
A rákos megbetegedések napjainkban világszerte a vezető haláloki tényezők közt szerepelnek, de máig vitatott, hogy kizárólag a modern kor emberét sújtó vagy a megelőző történeti korokban is pusztító kórról van-e szó.
Erre a kérdésre keressük a választ a régészet, a paleopatológia és a modern orvostudomány vizsgálati eszközeinek segítségével. A régészek által feltárt csontvázleleteken megfigyelhető kóros elváltozások néma tanúkként vallanak a rosszindulatú daganatok jelenlétéről az egykor élt emberek körében.
Budapest Science Meetup, 2014. szeptember 11.
Karen E. Alston is a top-performing sales and marketing executive with over 20 years of experience in the TV and radio industries. She has a proven track record of driving revenue growth through strategic marketing, sales training, and developing strong customer relationships. Currently she is the Sales Manager at FOX 24 and ABC 16 in Macon, Georgia, where she manages national and local accounts and has increased annual revenue from $1.8 million to over $6.8 million. Prior to her current role, she worked at WGXA FOX 24 and WMAZ-Radio where she consistently exceeded sales goals and revenue targets.
Mic Micro-dissection Testicular Sperm Extraction
(Micro-TESE)
Dr. Vishal Dutt Gour,
MBBS, MS, MCh (Urology)
Director, SCI International Hospital
M-4,GK-1,New Delhi-48
Learning Objectives
Understand the difference between obstructive (OA)
and non-obstructive azoospermia (NOA)
Overview of sperm retrieval techniques for NOA (micro
-TESE) and how to handle testicular sperm for ICSI
Learn the success rates and prognostic factors of sperm
retrieval in NOA using micro-TESE
Reproductive potential of Azoospermic men undergoing
assisted conception
Azoospermia
•It is not a synonymous of sterility
Obstructive
•Normal sperm production
Mechanical blockage
Vasectomy, Post-infectious, Congenital
Non-obstructive
Sperm production deficient or absent
Cryptorchidism, Orchitis, Radiation, Chemotherapy, Trauma, Genetic,
Gonadotoxins, Idiopathic
INTRODUCTION
•Microsurgical Testicular Sperm Extraction or “Micro-
TESE” has been developed to detect sperm in the
testicles of men who have poor sperm production.
•Because the testicular tubules are microscopic
structures, they cannot be distinguished by the naked
eye.
•There is a higher chance that he will find sperm in
“fuller,” more normal tubules than in scarred or fibrotic
tubules.
Microscope- why a good one is required
Approach
•Always plan to follow gradual stepwise approach to retrieve
sperm
•Percutaneous Semineferous Biopsy 3 to 4 sites using 18/20 G
Scalp Vein
•Deliver the testis and do a mapping to check
•Proceed with Micro TESA
•Micro-TESE can be performed as a diagnostic procedure
and if usable sperm are found, then they can be frozen
and the couple is recommended to proceed with ICSI.
•It can also be performed and timed with an egg
retrieval/IVF cycle so that the sperm are injected into the
eggs without freezing.
•Freezing the sperm from men with sperm production
problems can be difficult since these sperm are usually
few in number and don’t thaw well.
•Therefore the best chance of pregnancy is to use fresh sperm
obtained just prior to IVF.
•The chance of finding sperm with Micro-TESE is better than
60%. This is twice the chances of finding sperm by non-
microsurgical or needle biopsies taken by general urologists.
Micro-TESE is a great advance in male reproductive surgery, but
is only performed by a small number of male reproductive
surgeons.
This document provides an overview of intracytoplasmic sperm injection (ICSI). ICSI involves injecting a single sperm directly into a mature egg under a microscope, which differs from conventional in vitro fertilization where fertilization occurs outside the body. ICSI may be recommended for couples experiencing issues like low sperm counts, abnormal sperm, or problems with antibodies. The process involves sperm and egg retrieval followed by cleaning and injecting a sperm into an egg's cytoplasm. Success rates vary depending on patient factors, though ICSI enables fertilization when few sperm are available. Potential risks include genetic issues being passed to offspring if the father's sperm is abnormal.
There are several surgical procedures that can help treat male infertility by improving sperm production, delivery, or retrieval. Varicocele repair is the most common as it can improve semen parameters and pregnancy rates in 15% of infertile males. Vasectomy reversal has a 50-70% chance of pregnancy depending on if vasovasostomy or more involved vasoepididymostomy is needed. Ejaculatory duct obstruction may be treated with transurethral resection to relieve partial or complete blockage found in 1-5% of cases. For azoospermia, testicular sperm extraction techniques like microsurgical epididymal sperm aspiration combined with ICSI can achieve pregnancies in 76% of couples
Testicular Failure and Male Infertility - New Insights and Evolution of Trea...Sandro Esteves
1. The document discusses testicular failure, also known as non-obstructive azoospermia, which represents the most severe form of male infertility due to absent or minimal sperm production within the testicles.
2. It reviews treatment options for testicular failure including different sperm retrieval techniques like TESA, TESE, and micro-TESE which have success rates ranging from 15-67% depending on the technique.
3. The document also discusses that while factors like hormone levels and testicular volume cannot predict sperm retrieval success, the presence of AZFa or AZFb microdeletions on the Y chromosome indicates no chance of finding sperm, while AZFc deletions still allow for a 70
Testicular cancer occurs when abnormal cells in the testicles divide and grow uncontrolled. It is highly treatable and usually curable, with a cure rate of over 90% across all ages. The document discusses risk factors like age, undescended testicles, family history, and certain infections. It also describes the types of testicular cancers, signs and symptoms, diagnostic tests, and treatments which typically involve surgical removal of the testicle and lymph nodes, as well as potential chemotherapy or radiation therapy. Nursing care focuses on monitoring the patient during and after treatment and addressing issues related to body image, sexuality, and the importance of self-examination.
Testicular Sperm Retrieval and Poor Sperm Yield: How do we manage?Sandro Esteves
1. The document discusses testicular sperm retrieval and poor sperm yield in men with azoospermia.
2. It differentiates between obstructive and non-obstructive azoospermia, and notes that men with non-obstructive causes are more at risk of poor sperm yield from testicular sperm retrieval procedures.
3. The document provides guidance on how to identify men who are most at risk of poor sperm yield, such as those with Sertoli cell-only histopathology or non-mosaic Klinefelter syndrome, in order to select the most appropriate sperm retrieval method or potential interventions.
seminar (Undescended testes)
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes Majmaah University
The document summarizes various techniques for retrieving sperm from men with azoospermia for use in IVF-ICSI procedures. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval methods such as MESA, TESE, and microdissection TESE. It also covers evidence for techniques like FNA mapping followed by directed TESE to potentially improve sperm retrieval rates in men with non-obstructive azoospermia.
This document discusses various assisted reproductive technologies (ART) such as in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). It provides a brief history of ART and describes techniques like ovarian stimulation protocols, oocyte retrieval, fertilization, embryo culture, and preimplantation genetic diagnosis. Potential indications for ART include tubal factor infertility, endometriosis, and male factor infertility. Success rates are influenced by factors like maternal age and ovarian reserve.
The document discusses varicocele, a dilation of the veins within the scrotum that can affect male fertility. It notes that varicoceles occur in 15% of the male population and 35% of male infertility cases. The document recommends surgical treatment of varicoceles to improve semen parameters, sperm DNA integrity, and the likelihood of spontaneous and assisted pregnancy. It presents evidence that varicocele repair prior to IVF/ICSI procedures increases fertilization rates, live birth rates, and successful sperm retrieval compared to proceeding with IVF/ICSI without prior repair. The key takeaway is that surgical treatment of varicoceles has a positive impact on fertility outcomes.
Zero sperm count what the gynecologist should know by dr rupin shah, mdDr Aniruddha Malpani
This document discusses the management of azoospermia. It outlines the diagnostic algorithm doctors should follow to determine if the cause is obstructive or non-obstructive. For obstructive cases, surgery or sperm extraction and ICSI may be options. For non-obstructive cases, testicular biopsy is important to check for focal sperm production, as some men with testicular failure still have retrievable sperm. The document emphasizes that multiple biopsies may be needed and recommends techniques for optimizing sperm retrieval and diagnosis.
1) Assisted fertilization techniques like ICSI help sperm fertilize eggs by bypassing normal fertilization steps, allowing fertilization when sperm are few, non-moving, or absent.
2) For men with no sperm in their ejaculate (azoospermia), sperm can sometimes be retrieved from the testis using minor surgical procedures and then used for ICSI.
3) Success rates of pregnancy per embryo with assisted fertilization are similar to IVF for other causes, though risks of genetic abnormalities may be slightly higher due to underlying sperm defects.
Sperm Retreival: Optimizing Sperm Retrieval and Pregnancy in Nonobstructive A...The Turek Clinics
Dr. Paul Turek’s Society for the Study of Male Reproduction (SSMR) presentation at the American Urology Association (AUA) annual conference in Orlando, FL on Tuesday, May 20, 2014.
This document discusses issues related to treating male infertility in the era of ICSI. It argues that while ICSI provides an effective technique for bypassing sperm dysfunction, solely relying on ICSI and not properly diagnosing and treating the underlying causes of infertility can amount to negligence. The document emphasizes that andrology inputs are still important to address general health issues, infections, obstructions, hypogonadism, and genetic factors that may be contributing to poor sperm production or quality. A complete diagnosis and treatment of the male is important even in the ICSI era to help address underlying pathology and implications for health and inheritance.
This document discusses the management of non-obstructive azoospermia (NOA). It begins by defining NOA and providing statistics on prevalence. It then discusses the process of diagnosing NOA, including semen analysis and differential diagnosis. Etiologies of NOA including congenital and acquired causes are presented. Key points are made about selecting candidates for sperm retrieval based on etiology, biomarkers and genetic screening. Interventions prior to sperm retrieval for men with NOA and hypogonadism or clinical varicocele are discussed. The importance of proper laboratory handling of surgically extracted gametes is also mentioned. Overall, the document provides an overview of evaluating and managing men with NOA.
Testicular Failure in Humans: Current management and future perspectivesSandro Esteves
This document summarizes a presentation on testicular failure in humans. It discusses the current management and future perspectives on this condition. Some key points include:
- Spermatogenic failure is a challenging condition affecting 1% of men and is usually irreversible. About 40-50% of men with this condition still have residual spermatogenesis that can be retrieved.
- Diagnostic tests are not always accurate in predicting if sperm can be found, but a genetic assessment of the Y chromosome can provide helpful information.
- Different management approaches are used at Androfert clinic, including counseling, identifying candidates that may benefit from interventions before sperm retrieval, selecting the best sperm retrieval method, and using advanced lab techniques.
Public lecture - Stem Cell and Male InfertilitySandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Public Lecture - Stem Cell and Male Infertility
Dr. Anand K. Shinde is a gynecologist and director of andrology at IVF-Pune located at Deenanath Mangeshkar Hospital in Pune, India. He is president elect of the Pune Obstetrics and Gynecology Society and a founder member of the Indian Menopause Society. He discusses diagnostic testicular sperm extraction (TESA) and its ability to diagnose testicular issues and retrieve sperm for infertility treatments compared to testicular sperm extraction (TESE). While TESA is less invasive, TESE often retrieves more sperm and tissue, allowing for better diagnosis. Proper patient selection is important to determine the best extraction method.
This document discusses male infertility, including:
- The leading causes of male infertility are idiopathic abnormalities, varicocele, and infections which account for nearly 80% of cases.
- Male infertility can be evaluated through history, physical exam, semen analysis, and additional tests like hormone assays, immunological tests, and ultrasound.
- Factors that cause male infertility include genetic defects, infections, varicocele, sexual dysfunction, environmental exposures, and hormone imbalances. A thorough workup is needed to determine the specific etiology.
This document discusses sperm sorting techniques for men with high sperm DNA fragmentation index. It begins by defining sperm DNA damage and fragmentation, then discusses causes and indications for testing. It describes different tests to measure sperm DNA fragmentation and diagnostic cut-off points. The objectives and limitations of sperm sorting are outlined. Various sperm sorting techniques are explained, including swim-up, density gradient, magnetic activated cell sorting (MACS), motile sperm organelle morphology examination (MSOME), and surface charge-based sorting using hyaluronan binding. Advanced techniques like MSOME and MACS aim to select sperm with intact DNA and normal morphology to improve fertility outcomes.
This document summarizes a presentation on the management of male infertility. It discusses diagnosis of male infertility including semen analysis and tests of sperm DNA integrity. It reviews medical treatments including antioxidants and treatments for specific conditions like varicocele and hypogonadism. Surgical treatments for varicocele are discussed. Assisted reproduction techniques are summarized including outcomes of ICSI for treated vs untreated varicocele and sperm retrieval techniques for obstructive and non-obstructive azoospermia. Key findings are that varicocele repair and antioxidant treatment can improve fertility outcomes, while sperm retrieved from the testes have lower DNA damage than ejaculated sperm.
This document discusses sperm retrieval techniques for different types of azoospermia:
1) Obstructive azoospermia (OA) is caused by mechanical blockages and has normal sperm production, allowing for virtually 100% successful sperm retrievals.
2) Nonobstructive azoospermia (NOA) has deficient or absent sperm production in the testicles, so retrieval rates depend on the method used and testicular histopathology results.
3) Techniques for NOA include micro-TESE, TESA, and conventional TESE, with micro-TESE having higher success rates. PESA and TESA are used for OA.
**Introduction:**
Epispadias is a rare congenital malformation affecting the genitourinary system. This condition disrupts the normal development of the urethra and surrounding structures during fetal growth. Understanding epispadias involves delving into its definition, types, signs and symptoms, as well as the diagnostic evaluation methods employed to assess this anomaly.
**Definition:**
Epispadias is a congenital anomaly where the urethral opening is positioned on the upper side of the penis rather than its usual location at the tip. This abnormality can extend to involve the bladder and adjacent structures, impacting urinary and reproductive functions.
**Types:**
Epispadias is categorized into three main types based on the severity of the malformation: glandular, penile, and penopubic. Glandular epispadias involves the urethral opening being near the glans, while penile epispadias extends along the penile shaft. Penopubic epispadias is the most severe type, reaching the pubic region.
**Signs and Symptoms:**
Common signs of epispadias include an abnormally placed urethral opening, exposed glans, and a widened pubic gap. Individuals with epispadias may experience urinary incontinence, as the abnormal positioning of the urethra can affect urinary control. Additionally, this condition may be associated with other genitourinary abnormalities.
**Diagnostic Evaluation:**
Diagnosing epispadias involves a thorough clinical examination and imaging studies. Physical examination may reveal the characteristic features, while imaging techniques such as ultrasound, magnetic resonance imaging (MRI), or voiding cystourethrogram (VCUG) can provide detailed insights into the extent of the malformation and associated abnormalities. Timely and accurate diagnosis is crucial
Novel concepts in male factor infertility: clinical and laboratory perspectivesSandro Esteves
Presentation Objectives:
1. Update on the WHO reference values for semen parameters, and understand the role of sperm DNA fragmentation testing to decision-making strategies;
2. Learn how to counsel azoospermic men seeking fertility, and the role of gonadotropin therapy in this infertility condition;
3. Understand the benefits of microsurgery to both sperm retrieval and varicocele treatment;
4. Appraise the role of medical and surgical interventions to infertile men undergoing ART.
Clinical management of men with nonobstructive azoospermia - Sperm Retrieval ...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 4: Sperm Retrieval Methods in Nonobstructive Azoospermia
This document discusses varicose veins and venous insufficiency. It begins by outlining the relevant anatomy of the superficial, deep, and perforating venous systems. It then discusses the pathophysiology of venous insufficiency, including mechanical abnormalities, cellular abnormalities, and molecular abnormalities that can cause decreased elasticity and permeability. The document categorizes venous insufficiency as either primary/familial or secondary. It lists risk factors, symptoms, and examination findings. Diagnostic tools like Doppler ultrasound and treatment options including compression stockings, sclerotherapy, and surgery are covered. Sample exam questions are provided at the end.
Similar to Sperm Retrieval Techniques - Looking for a Needle in the Haystack (20)
Oocyte number, female and male age, and ART outcomes Sandro Esteves
This document summarizes Sandro Esteves' presentation on optimizing ART success through individualizing oocyte retrieval targets based on a patient's age and ovarian reserve. It discusses:
1) The decline in blastocyst euploidy rates with increasing female age and the importance of oocyte quantity and quality for ART success.
2) The Poseidon criteria for stratifying "low prognosis" ART patients based on age and expected oocyte yield.
3) A mathematical model developed to estimate the minimum number of oocytes needed to achieve at least one euploid blastocyst based on a patient's age.
4) How individualizing treatment based on this oocyte target number can maximize ART efficiency
Luteal Phase Support: Key Variables to Achieve Success in ARTSandro Esteves
This document discusses luteal phase support in assisted reproductive technology cycles. It covers:
1. The pathophysiology of the luteal phase defect in stimulated cycles and the role of progesterone supplementation.
2. Different luteal phase support protocols after hCG trigger in fresh embryo transfer cycles, including progesterone alone versus progesterone plus hCG or GnRH agonist.
3. Luteal phase support considerations for frozen embryo transfer cycles, including the type and timing of estrogen and progesterone administration.
Understanding Strategies to Maximize Cumulative Live Birth RateSandro Esteves
1. The document discusses strategies for maximizing success in assisted reproductive technology (ART) treatment by stratifying patients based on factors that influence prognosis, such as age, ovarian reserve markers, and previous response to ovarian stimulation.
2. It introduces the Poseidon criteria for stratifying patients into four groups based on their predicted prognosis: two groups include younger or older patients with a previously suboptimal response, and two groups include those with expected poor ovarian reserve.
3. Stratifying patients according to factors of both oocyte quantity and quality allows for a more individualized treatment approach aimed at obtaining the estimated number of oocytes needed for achieving at least one euploid embryo transfer for each patient.
Role of LH in Controlled Ovarian StimulationSandro Esteves
1) The document discusses the role of LH in controlled ovarian hyperstimulation (COH). It notes that LH plays important roles in folliculogenesis and steroidogenesis.
2) It reviews rationales for LH supplementation in COH, such as lower endogenous LH levels and impaired steroidogenesis in certain patient groups.
3) Studies show LH supplementation can improve outcomes for poor responders and older patients, though effects may depend on the patient subgroup and study design. More research is still needed to determine which specific patient populations benefit most.
Air quality: is it that important? And if so, how to measure and control it?Sandro Esteves
Quality and Risk Management in the IVF Laboratory; Redlara Brasil, Belo Horizonte, 14-15 September 2016
Content:
1.Air quality: is it that important?
2. How to control?
3. How to measure?
Técnicas de Obtencão de Espermatozóides na Azoospermia - Como fazer?Sandro Esteves
This document discusses different techniques for obtaining sperm from men with azoospermia, including:
1) PESA, MESA, TESA, TESE, and Micro-TESE which are used to retrieve sperm from the epididymis or testicles.
2) Micro-TESE has higher sperm retrieval rates compared to conventional TESE, especially for men with non-obstructive azoospermia.
3) Sperm retrieved through Micro-TESE also has higher fertilization rates and live birth rates compared to TESE or techniques for obstructive azoospermia.
O documento discute varicocele e infertilidade masculina. Resume que:
1) Varicocele é causa comum de infertilidade masculina, associada a deterioração dos parâmetros seminais e função testicular;
2) A fisiopatologia envolve hipertermia, hipóxia e estresse oxidativo testicular devido ao refluxo venoso;
3) O tratamento da varicocele, seja cirúrgico ou por embolização, melhora os parâmetros seminais e fertilidade em muitos casos.
1. O documento discute como realizar uma revisão de artigos científicos de forma objetiva e construtiva.
2. São apresentados os objetivos da revisão por pares, as responsabilidades do revisor e dicas sobre como escrever comentários para o editor e autores.
3. O documento fornece diretrizes detalhadas para que os revisores avaliem com qualidade os artigos submetidos prestando um serviço útil aos editores e autores.
Este documento discute conceitos estatísticos importantes para a condução de pesquisas, como poder amostral, escolha do teste estatístico correto, intervalo de confiança e cálculo do tamanho amostral. O documento enfatiza que é crucial escolher o teste estatístico apropriado para o tipo de dados, evitar erros tipo I e II, e justificar o tamanho da amostra utilizada para validar conclusões.
Clinical management of men with nonobstructive azoospermia - Role of IVF Labo...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 5: Role of IVF Laboratory in Nonobstructive Azoospermia
Clinical management of men with nonobstructive azoospermia - Steps Before Spe...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 3: Steps Before Sperm Retrieval in Nonobstructive Azoospermia
Clinical management of men with nonobstructive azoospermia - Chances of Harve...Sandro Esteves
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
Clinical management of men with nonobstructive azoospermia - Azoospermia Diff...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 1: Azoospermia Differential Diagnosis
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Sperm Retrieval Techniques - Looking for a Needle in the Haystack
1. 2012 Summer Internship Program
Cleveland Clinic Reproductive Research Center
Sandro Esteves, MD, PhD
Director, ANDROFERT
Center for Male Reproduction and Infertility
Campinas, BRAZIL
2. Learning Objectives
Understand azoospermia and the differences
between obstructive and nonobstructive subtypes
Learn the available methods for sperm acquisition
in azoospermia and their indications
Learn the success rates of sperm retrieval in
different azoospermia scenarios
Understand the reproductive potential of
azoospermic men undergoing assisted conception
Esteves, 2
3. Review this lecture at:
http://bit.ly/ccfsummerinterns2012
Pdf slides
Videos
Reference papers
4. Spermatogenesis
Where do we stand compared to our relatives?
Chimpanzee Human Gorilla
100 lbs 180 lbs 600 lbs
64 cc 20 cc 14 cc
>1 64 5
billion/mL million/mL million/mL
5. Sperm Count in Humans
General Population of Unscreened Men
Centiles
2.5% 50% 97.5%
Sperm count
per mL (x106) 4 64 237
Azoospermia
• Complete absence of sperm in the ejaculate
• 1-3% male population
• ~10% male infertility population
Cooper et l. Hum Reprod Update 2009; Esteves et al, CLINICS 2011
6. Semen Analysis and
Azoospermia
Centrifugation
at 3,000g for
15 minutes
The supernatant is
discharged and the
pellet is examined
Esteves, 6
7. Types of Azoospermia
Non-
Obstructive obstructive
• Normal sperm production • Absent or minimal sperm
• Mechanical blockage anywhere production within the
along the reproductive tract testicles
• Epididymis • Testicular failure
• Vas Deferens
• Ejaculatory Duct
9. Management of Azoospermia
OA NOA
non-
treatable
treatable
ductal sperm
reconstruc- retrieval
tion and ICSI
Esteves et al. An update on the initial assessment of the infertile male.
CLINICS 2011;66:1-10.
10. 1. Azoospermia is a descriptive
term of ejaculates that lack
spermatozoa without
implying a specific underlying
cause.
2. Azoospermia is not synonymous of sterility.
Treatment options are microsurgical ductal
reconstruction (selected cases of OA) and sperm
retrieval coupled with in vitro fertilization (ICSI).
11. Sperm Retrieval Goals
Immediate
use for
Obtain ICSI
sperm
for ICSI
Cryopreservation
Future
retrievals
Minimize
damage
Testicular
function
12. Sperm Retrieval Techniques
Technique Acronym Indications
Percutaneous Epididymal PESA OA cases only
Sperm Aspiration
Microsurgical Epididymal MESA OA cases only
Sperm Aspiration
Testicular Sperm Aspiration TESA; Failed PESA in OA
TEFNA1 Epididymal agenesis in CAVD
Favorable histopathology in NOA
Previous SR success in NOA
Testicular Sperm Extraction TESE Failed PESA or TESA in OA
(single or multiple biopsies) NOA cases
Microsurgical Testicular Micro-TESE NOA cases only
sperm Extraction
Esteves et al. Sperm Retrieval Techniques for Assisted Reproduction.
Esteves, 12
Int Braz J Urol 2011; 37(5):570-83
13. Sperm Retrieval in Obstructive
Azoospermia
• Epididymis
• Testicle
• Simple and Effective
Esteves SC & Agarwal A. Sperm Retrieval Techniques; In: Gardner D et al (Eds.), Human
Esteves, 13 Assisted Reproductive Technology. Cambridge University Press, pp. 41-53, 2011.
14. Percutaneous Sperm Retrieval in
Obstructive Azoospermia
Please visit http://androfert.com.br/videos to watch this video
15. PESA alone
PESA + rescue TESA
97.3
%
OBSTRUCTIVE AZOOSPERMIA
100% 96.6% 96.3%
78.1
%
Successful Retrievals CBAVD Vasectomy Post-infection
Esteves et al. Reproductive potential of men with OA undergoing percutaneous
sperm retrieval and ICSI according to the cause of obstruction. J Urol
Esteves, 15
2012, submitted.
16. Epididymal/Testicular sperm Ejaculated sperm
70 73.6
P>0.05
48.5 46.3 51.3
43.2
20
12.1
%2PN %Top quality % Pregnancy % Miscarriage
Fertilization embryos
Verza Jr S & Esteves SC. Sperm defect severity rather than sperm source is associated
with lower fertilization rates after intracytoplasmic sperm injection.
Int Braz J Urol 2008; 34:49-56.
Esteves, 16
17. CBAVD Post-vasectomy Post-infection
P>0.05 265 277 250
Maformation rate: 1.5%
Perinatal mortality: 1.5%
34.4 32.2 36.4 35.8 37.0 35.5
% Live birth Gestational age (wks) Birth weight
(gramsx10)
Esteves et al. Reproductive potential of men with OA undergoing percutaneous
sperm retrieval and ICSI according to the cause of obstruction. J Urol
Esteves, 17
2012, submitted.
19. Non-obstructive
Untreatable Azoospermia
condition
Small testes/elevated FSH/”sterile”
Absent or minimal production for
sperm to appear in ejaculate
Heterogeneity of sperm production:
600-800 seminiferous tubules/testis;
Single focus of production adequate to
retrieve spermatozoa for ICSI
Goal: To identify and retrieve
sperm for ICSI, but…
Geographic location unpredictable
Esteves, 19
20. Can We Predict Sperm Retrieval
Success in NOA?
Important because:
1. Can minimize emotional and financial cost of IVF
cycles.
2. Can minimize trauma/damage to testis during sperm
harvesting.
Esteves, 20
21. Predictive Value of Noninvasive Tests
for Sperm Retrieval in NOA
FSH Testosterone
Testicular Volume
Verza Jr. & Esteves. Fertil Steril 2011; 96: S53
Esteves, 21
22. Predictive Value of Noninvasive
Tests for Sperm Retrieval in NOA
Y Chromosome Microdeletion Screening
Prevalence of Yq microdeletions:
1:2.000-3.000 newborns
Azoospermic men: 5-12%
Esteves, 22
Esteves, Miyaoka & Agarwal. An update on the initial assessment of the
infertile male. CLINICS 2011; 66:1-10.
23. Predictive Value of Noninvasive
Tests for Sperm Retrieval in NOA
Y Chromosome Microdeletion Screening
AZFb
deletion
Absence of
retrievable sperm
Esteves SC & Agarwal A. Novel concepts in male infertility.
Esteves, 23
Int Braz J Urol 2011; 37:5-15.
24. Predictive Value of Invasive
Tests for Sperm Retrieval
in NOA
Testicular Histopathology
Sensitivity Specificity (95% Accuracy
(95% CI) CI) (%)
HYPO 93 (66-100) 70 (54-82)
MA 64 (31-89) 59 (44-73) 81.9
SCO 20 (08-37) 20 (07-41)
Esteves, Miyaoka & Agarwal. Surgical Treatment of Male Infertility in the ICSI Era.
Esteves, 24 CLINICS 2011; 66:1463-77.
27. Nonobstructive Azoospermia
TESA vs. TESE
Controlled studies Needle Open Biopsy
for NOA men Aspiration
Friedler et al., 4/37 (11%) 16/37 (43%)
Human Reprod 12:1488, 1997
Ezeh et al. 5/35 (14%) 22/35 (63%)
Human Reprod 13:3075, 1998
28. Conventional TESE (open biopsy)
in NOA
Number of patients 25
20
15
10
5
0
1 2 3 4 7 8 9 10 14
Number of testicular fragments excised
Ostad et al., Urology 52:692, 1998.
Esteves, 28
29. Nonobstructive Azoospermia
Testicular 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 PN. Testicular sperm extraction: microdissection improves sperm yield with
minimal tissue excision. Hum Reprod. 1999;14:131-135.
31. Schlegel 1999
Amer et al. 2000
Micro-
Okada et al. 2002
TESE
43%-53%
Okubu et al. 2002
Tsujimura et al. 2002 TESE
25%-41%
Ramon et al. 2003
Esteves et al. 2011
32. 1. Sperm retrieval
techniques are surgical
methods to collect
spermatozoa from the
epididimys or the testis of
azoospermic men seeking
fertility.
2. The method of choice is based primarily upon
the type of azoospermia being obstructive or
nonobstructive.
3. Retrieved sperm should be used for ICSI or
cryopreserved for a future ICSI attempt.
33. Microsurgical vs Single-Biopsy TESE
in Nonobstructive Azoospermia
Controlled series of 60 patients
Sperm Retrieval Success Rates
Micro-TESE single-biopsy TESE
93%
Method Histology categories
P=0.0005 64% 64% pairwise
45%
comparisons
P<0.0001
25% 20%
9% 6%
Overall Hypospermatogenesis Maturation Arrest Sertoli-cell Only
Microsurgical versus conventional single-biopsy testicular sperm extraction in
nonobstructive azoospermia: a prospective controlled study
Esteves, 33 Verza Jr S, Esteves SC. Fertil Steril 2011; 96 (3): S53
34.
35. Hypospermatogenesis
Sertoli cell-only
Verza Jr & Esteves, Atlas of Human Reproduction, SBRH 2012
36. Conventional TESE Micro-TESE
Microsurgical vs Single-
Biopsy TESE in
Nonobstructive
Azoospermia
Fragment weight Fragment weight
Tissue Removal
Open Large Micro- P-
Single-Biopsy TESE value
TESE
Tissue Removed (mg) 65 ± 25 8.9 ± 2.5 <0.01
Esteves, 36
Verza Jr & Esteves. Fertil Steril 2011; 96 (3): S53
37. Success of Sperm Retrieval
by Cause of NOA
Cryptorchidism 52-74%
Varicocele 63-68%
Post-infection 67%
Torsion >50%
Post-chemotherapy/RT 25-75%
Genetic (Klinefelter, AZFc Yq microdeletions) 25-70%
Idiopathic 50-60%
OVERALL 40-60%
Esteves et al., Fertil Steril 94; 2010; Raman and Schlegel. J Urol.170; 2003;
Hopps et al. Hum Reprod. 180, 2003; Damani et al. JCO. 15; 2002
38. No. of Patients 255
% Retrieval Rate 51.1
No. ICSI cycles 328
Mean ± SD Patient Age
Male 37.0 ± 7.6
Female 32.4 ± 4.7
Mean ± No. Injected Oocytes 9.8 ± 7.2
Mean ± %2PN Fertilization 43.7 ± 27.9
No. Transfer 298
Mean ± No. Embryos Transferred 2.4
No. Clinical Pregnancy (%) 86 (28.9)
No. Live birth (%) 64 (21.5)
Esteves, 38
39. No. of Babies Born 102
No. Multiple Deliveries (%) 29 (28.4)
Mean ± SD Gestational Age 35.5 ± 2.7
Mean ± Birth Weight 2532 ± 601
Gender ratio; boy/girl 1.0/1.3
No. Perinatal Deaths 6 (5.9)
No. Birth Defects (%) 3 (2.9)
Esteves, 39
40. Sperm Retrieval Success Rates and
Reproductive Potential of Azoospermic
Men undergoing ICSI
Obstructive (N=142) Nonobstructive (N=172)
97.9%
55.2%
38.2%
25.0%
Successful Sperm Retrieval Live Birth rate
Odds-ratio 43.0 1.86
95% CI 10.3 – 179.5 1.03 – 2.89
P-value <0.01 0.03
Prudencio C, Seoul B, Esteves SC. Reproductive potential of azoospermic men
undergoing intracytoplasmic sperm injection is dependent on the type of azoospermia.
Fertil Steril 2010; 94(4):S232-3.
43. 1. Nowadays, the use of
surgically-retrieved
sperm and ICSI has
become an established
procedure for couples
wishing to obtain a
biological offspring in
whom the male partner
have azoospermia.
2. So far, the post-natal outcomes of babies born
from such fathers are reassuring.
44. Learning Objectives
Understand azoospermia and the differences
between obstructive and nonobstructive subtypes
Azoospermia is the lack of sperm in the ejaculate
Should be confirmed by semen analysis with
centrifugation and pellet examination
Found in ~10% of the male infertility population
Types are Obstructive and Nonobstructive
Congenital, acquired and unknown etiologies
AO: sperm production is normal
NOA: sperm production severely abnormal or absent
Esteves, 44
45. Learning Objectives
Learn the available methods for sperm acquisition
in azoospermia and their indications
Percutaneous (PESA, TESA) and open
(MESA, TESE, micro-TESE) techniques are
available
Epididymides and testicles are the target organs
Epididymal retrievals: Obstructive azoospermia
Testicular retrievals: AO and NOA
Microdissection TESE for the most difficult cases of NOA
Esteves, 45
46. Learning Objectives
Learn the success rates of sperm retrieval in
different azoospermia scenarios
Sperm retrieved in virtually all cases of OA
Not related to collection method or cause of obstruction
Sperm retrieved in 40-60% of NOA cases
Current testing not reliable to predict SR success
Success not related to the cause of NOA
Men with AZF a or b microdeletions not candidates
Higher SRR with micro-TESE
Esteves, 46
47. Learning Objectives
Understand the reproductive potential of
azoospermic men undergoing assisted conception
Success of ICSI
Not related to collection method
Related to the type of azoospermia
Follow-up of children born similar outcomes (few data)
Obstructive Azoospermia
Similar (or better) results than ejaculated sperm
~40% live birth rates
Nonobstructive Azoospermia
Lower results than other infertility causes
~25% live birth rates
Esteves, 47