1
|
Aponte PM, Gutierrez-Reinoso MA, Garcia-Herreros M. Bridging the Gap: Animal Models in Next-Generation Reproductive Technologies for Male Fertility Preservation. Life (Basel) 2023; 14:17. [PMID: 38276265 PMCID: PMC10820126 DOI: 10.3390/life14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
This review aims to explore advanced reproductive technologies for male fertility preservation, underscoring the essential role that animal models have played in shaping these techniques through historical contexts and into modern applications. Rising infertility concerns have become more prevalent in human populations recently. The surge in male fertility issues has prompted advanced reproductive technologies, with animal models playing a pivotal role in their evolution. Historically, animal models have aided our understanding in the field, from early reproductive basic research to developing techniques like artificial insemination, multiple ovulation, and in vitro fertilization. The contemporary landscape of male fertility preservation encompasses techniques such as sperm cryopreservation, testicular sperm extraction, and intracytoplasmic sperm injection, among others. The relevance of animal models will undoubtedly bridge the gap between traditional methods and revolutionary next-generation reproductive techniques, fortifying our collective efforts in enhancing male fertility preservation strategies. While we possess extensive knowledge about spermatogenesis and its regulation, largely thanks to insights from animal models that paved the way for human infertility treatments, a pressing need remains to further understand specific infertility issues unique to humans. The primary aim of this review is to provide a comprehensive analysis of how animal models have influenced the development and refinement of advanced reproductive technologies for male fertility preservation, and to assess their future potential in bridging the gap between current practices and cutting-edge fertility techniques, particularly in addressing unique human male factor infertility.
Collapse
Affiliation(s)
- Pedro M. Aponte
- Colegio de Ciencias Biológicas y Ambientales (COCIBA), Universidad San Francisco de Quito (USFQ), Quito 170901, Ecuador
- Instituto de Investigaciones en Biomedicina “One-Health”, Universidad San Francisco de Quito (USFQ), Campus Cumbayá, Quito 170901, Ecuador
| | - Miguel A. Gutierrez-Reinoso
- Facultad de Ciencias Agropecuarias y Recursos Naturales, Carrera de Medicina Veterinaria, Universidad Técnica de Cotopaxi (UTC), Latacunga 050150, Ecuador;
- Laboratorio de Biotecnología Animal, Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción (UdeC), Chillán 3780000, Chile
| | - Manuel Garcia-Herreros
- Instituto Nacional de Investigação Agrária e Veterinária (INIAV), 2005-048 Santarém, Portugal
| |
Collapse
|
2
|
Microfluidic Systems for Isolation of Spermatozoa from Testicular Specimens of Non-Obstructive Azoospermic Men: Does/Can It Improve Sperm Yield? J Clin Med 2021; 10:jcm10163667. [PMID: 34441963 PMCID: PMC8397192 DOI: 10.3390/jcm10163667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) has allowed reproduction options through assisted reproductive technologies (ARTs) for men with no spermatozoa within the ejaculate (azoospermia). In men with non-obstructive azoospermia (NOA), the options for spermatozoa retrieval are testicular sperm extraction (TESE), testicular sperm aspiration (TESA), or micro-surgical sperm extraction (microTESE). At the initial time of spermatozoa removal from the testis, spermatozoa are immobile. Independent of the means of spermatozoa retrieval, the subsequent steps of removing spermatozoa from seminiferous tubules, determining spermatozoa viability, identifying enough spermatozoa for oocyte injections, and isolating viable spermatozoa for injection are currently performed manually by laboratory microscopic dissection and collection. These laboratory techniques are highly labor-intensive, with yield unknown, have an unpredictable efficiency and/or success rate, and are subject to inter-laboratory personnel and intra-laboratory variability. Here, we consider the potential utility, benefits, and shortcomings of developing technologies such as motility induction/stimulants, microfluidics, dielectrophoresis, and cell sorting as andrological laboratory add-ons to reduce the technical burdens and variabilities in viable spermatozoa isolation from testicular samples in men with NOA.
Collapse
|
3
|
Cito G, Coccia ME, Sessa F, Cocci A, Verrienti P, Picone R, Fucci R, Criscuoli L, Serni S, Carini M, Natali A. Testicular Fine-Needle Aspiration for Sperm Retrieval in Azoospermia: A Small Step toward the Technical Standardization. World J Mens Health 2019; 37:55-67. [PMID: 30584991 PMCID: PMC6305866 DOI: 10.5534/wjmh.180077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The aim was to describe our preliminary experience performing testicular fine-needle aspiration (TEFNA) with a larger needle in infertile patients with obstructive azoospermia, and to provide a systematic literature review of the different testicular sperm aspiration techniques, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. MATERIALS AND METHODS We prospectively collected data between March 2017 and June 2018. All men underwent bilateral TEFNA under analgo-sedation, using a larger disposable 18-gauge butterfly needle with 60 mL Luer-Lock syringe attached to it. RESULTS Thirty consecutive patients were enrolled. Median operative time was 16 minutes (interquartile range [IQR]: 12-30 minutes). No intraoperative complications occurred. Two/thirty patients (6.7%) reported postoperative adverse events: 1 patient had prolonged orchialgia, 1 patient presented scrotal hematoma. Successful sperm retrieval was found in 28/30 cases (93.3%). Median sperm concentration was 0.05 ×10⁶/mL (IQR: 0.001-0.1 ×10⁶/mL). Median total sperm motility was 10% (IQR: 0%-15%). In 20/30 men (66.7%) sperm retrieved was used for fresh intracytoplasmic sperm injection cycle, in 8/30 (26.7%) sperm cryopreservation was necessary, because on the day of sperm retrieval the female resulted not responder to ovarian stimulation. In this cases mean number of 3 (IQR: 1-4) bio system straws was cryopreserved. CONCLUSIONS TEFNA with 18-gauge needle proved to be a feasible, safe and effective treatment, even if future prospective studies will be addressed to clarify what type of azoospermia benefits from this procedure, and if a larger needle permits to improve Assisted Reproductive Technologies (ART) outcomes.
Collapse
Affiliation(s)
- Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria Elisabetta Coccia
- Assisted Reproductive Technology Center, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
| | - Pierangelo Verrienti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Center, Careggi Hospital, University of Florence, Florence, Italy
| | - Rossella Fucci
- Assisted Reproductive Technology Center, Careggi Hospital, University of Florence, Florence, Italy
| | - Luciana Criscuoli
- Assisted Reproductive Technology Center, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| |
Collapse
|
4
|
Stark D, Stiller R, Xie M, Weber D, Maggiorini M, Hilty MP. Preserving fertility in an unconscious patient with Goodpasture syndrome-medicolegal and ethical aspects. J Intensive Care 2018; 6:40. [PMID: 30062013 PMCID: PMC6056934 DOI: 10.1186/s40560-018-0311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Every day in the ICU, legal issues arise while treating sedated, unconscious, and legally incapacitated patients. Whenever a life-saving treatment cannot be discussed in a timely manner with an unconscious patient, doctors are required by law to act according to the substituted judgment standard. However, if it is not survival that is at stake, but conservation of reproduction and the potential side effects are significant, the decision-making process becomes much more difficult. Legal issues associated with possible harm to the patient on the one hand and ethical issues with presumable benefit of the intervention on the other hand give rise to difficult decisions. Case presentation We present the case of a 24-year-old patient with Goodpasture syndrome. Because of rapid aggravation of kidney function and alveolar hemorrhage-the latter requiring an urgent initiation of mechanical ventilation-therapy with steroids, plasmapheresis, and cyclophosphamide was immediately required. Knowledge of the negative impact on fertility brought up the question about sperm cryopreservation. According to the substituted judgment standard, together with the mother of the patient and based on interdisciplinary evaluation of the situation with specialists from the reproductive endocrinology and urology department, the decision for a testicular sperm extraction in the absence of the possibility to obtain the patient's informed consent was made. Immediate chemotherapy was initiated and continued after the procedure. The patient recovered from the acute illness and was informed retrospectively about the testicular sperm extraction, which he received extremely positively. Conclusion Our aim is to highlight the legal objectives and ethical aspects of a non-lifesaving but fertility-preserving intervention in an unconscious patient. The need for decision-making in this kind of situation is rare and therefore challenging. The present case may serve to encourage and guide other doctors in similar situations.
Collapse
Affiliation(s)
- Doreen Stark
- 1Medical Intensive Care Unit, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ruth Stiller
- 2Department of Reproduction Endocrinology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Min Xie
- 2Department of Reproduction Endocrinology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Damian Weber
- 3Department of Urology, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Marco Maggiorini
- 1Medical Intensive Care Unit, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Peter Hilty
- 1Medical Intensive Care Unit, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
5
|
Polland A, Berookhim BM. Fertility concerns in men with genitourinary malignancies: Treatment dilemmas, fertility options, and medicolegal considerations. Urol Oncol 2016; 34:399-406. [DOI: 10.1016/j.urolonc.2016.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022]
|
6
|
Jensen CFS, Ohl DA, Hiner MR, Fode M, Shah T, Smith GD, Sonksen J. Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men. Andrology 2016; 4:257-62. [DOI: 10.1111/andr.12143] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/31/2015] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. F. S. Jensen
- Department of Urology; University of Michigan; Ann Arbor MI USA
- Department of Urology; Herlev University Hospital; Herlev Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - D. A. Ohl
- Department of Urology; University of Michigan; Ann Arbor MI USA
| | - M. R. Hiner
- Department of Obstetrics and Gynecology; University of Michigan; Ann Arbor MI USA
| | - M. Fode
- Department of Urology; Herlev University Hospital; Herlev Denmark
| | - T. Shah
- Department of Obstetrics and Gynecology; University of Michigan; Ann Arbor MI USA
| | - G. D. Smith
- Department of Urology; University of Michigan; Ann Arbor MI USA
- Department of Obstetrics and Gynecology; University of Michigan; Ann Arbor MI USA
| | - J. Sonksen
- Department of Urology; Herlev University Hospital; Herlev Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
7
|
Tiseo BC, Hayden RP, Tanrikut C. Surgical management of nonobstructive azoospermia. Asian J Urol 2015; 2:85-91. [PMID: 29264125 PMCID: PMC5730741 DOI: 10.1016/j.ajur.2015.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/20/2014] [Accepted: 12/24/2014] [Indexed: 11/20/2022] Open
Abstract
Nonobstructive azoospermia (NOA) is characterized by the complete absence of sperm in the ejaculate due to testicular failure. The evaluation and management of patients with NOA offer a challenge to the reproductive urologist. In the era of in vitro fertilization with intracytoplasmic sperm injection, surgical sperm extraction techniques can afford men with NOA biologic paternity. To provide a comprehensive review of surgical sperm retrieval approaches in the patient with NOA emphasizing complications, success rates and outcome optimization, a Medline search was conducted querying surgical approaches used to manage NOA. Four sperm extraction techniques are described including: testicular sperm aspiration, testicular sperm extraction, fine needle aspiration mapping and microdissection testicular sperm extraction. In addition, the roles for pre-extraction varicocelectomy and sperm cryopreservation are discussed. The management of NOA continues to evolve as newer tools become available. Several modalities of sperm acquisition exist. An understanding of their complications and success rates is fundamental to the treatment of NOA.
Collapse
Affiliation(s)
- Bruno Camargo Tiseo
- Reproduction Center, Urology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Russell Paul Hayden
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cigdem Tanrikut
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Tiseo BC, Hayden RP, Tanrikut C. WITHDRAWN: Surgical management of nonobstructive azoospermia. Asian J Urol 2015. [DOI: 10.1016/j.ajur.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
9
|
Abstract
Technical refinements in sperm retrieval methods and the application of advanced reproductive technologies (ART) using surgically retrieved sperm have enabled biological paternity in azoospermic men who were considered untreatable 20 years ago. Achievement of optimal reproductive outcomes in these patients benefits greatly from a multistep, interdisciplinary process of sperm acquisition that involves reproductive endocrinologists, urologists, or other specialists in male subfertility, and laboratory personnel with expertise in characterizing and isolating sperm from surgically retrieved specimens. The critical steps in this process are discussed in this chapter.
Collapse
Affiliation(s)
- Peter J Stahl
- Department of Urology, Columbia University Medical Cente, 161 Fort Washington Ave 11th floor, New York, NY, 10032, USA
| | | | | |
Collapse
|
10
|
Abouhashem SE, Saba I, Mostafa S, Abdalla A, Almaramhy H, Mostafa M, Elsayed D, Ibrahim E, Maroof A, Eladl M. The validity of testicular aspirate cytology and DNA image-analysis of the aspirate in the assessment of infertile men. Arab J Urol 2013; 11:91-100. [PMID: 26579253 PMCID: PMC4442955 DOI: 10.1016/j.aju.2012.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/02/2012] [Accepted: 12/06/2012] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the possibility of using cytological examination and DNA image-analysis of testicular fine-needle aspirates instead of open surgical biopsy in the investigation of infertile men, as testicular biopsy has long been used for investigating infertility but the interpretation of histological slides is usually subjective. Patients and methods Thirty-three men (aged 22–36 years) were evaluated for infertility and underwent both open biopsy and fine-needle aspiration of their testes. Subsequently, the needle aspirates were assessed histopathologically and cytologically, and by DNA image cytometry. The percentages of haploid, diploid and tetraploid cells were determined for each patient. Results The cases were divided into four categories: (1) Complete spermatogenesis, with a DNA pattern of 1n > 2n > 4n; (2) Maturation arrest, with a DNA pattern of 2n > 4n with no haploid cells; (3) Sertoli cell-only syndrome, with a DNA pattern of only 2n, with no haploid or tetraploid cells; (4) Hypospermatogenesis, with a variable DNA pattern, i.e. mild with 1n > 2n, moderate with 2n > 1n > 4n, and marked where the DNA pattern was 2n > 4n > 1n. From the cytological and DNA image-analysis of the aspirate a diagnosis was possible that had a strong correlation with the histological diagnosis of the same case. From image analysis we could exclude interstitial cells, Sertoli cells and sperms on the static image, and differentiate between spermatozoa and spermatids based on morphological characteristics in the cytological smear. This technique can therefore be used to quantitatively determine the percentages of various cell types within the seminiferous tubules. By coupling image ploidy analysis and cytological examination of a cytological smear, spermatogenesis can be assessed accurately. Conclusion Image cytometry could be used to exclude interstitial cells, Sertoli cells and sperms on the static image and so produce an accurate assessment of spermatogenesis. A combination of ploidy and cell morphology characteristics in cytological smears provides an accurate, reproducible and easily used alternative to open testicular biopsy.
Collapse
Affiliation(s)
- Safwat E Abouhashem
- Departments of Urology, Zagazig University, Egypt ; Department of Surgery, Taiba University, Saudi Arabia
| | - Isam Saba
- Departments of Pathology, Zagazig University, Egypt
| | | | - Alaa Abdalla
- Departments of Urology, Zagazig University, Egypt
| | | | | | | | - Ehab Ibrahim
- Departments of Urology, Zagazig University, Egypt
| | - Aref Maroof
- Departments of Urology, Zagazig University, Egypt
| | | |
Collapse
|
11
|
Recovery, isolation, identification, and preparation of spermatozoa from human testis. Methods Mol Biol 2012; 927:227-40. [PMID: 22992917 DOI: 10.1007/978-1-62703-038-0_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In some cases, human spermatozoa to be used for in vitro fertilization are processed from testicular or epididymal biopsies collected in the clinic or operating room. An appropriately equipped Andrology or Embryology Laboratory is required. Sterility must be maintained at all stages from collection and transport to identification and processing to insemination or cryopreservation. The technologist must be able to properly process and identify spermatozoa from aspirates, seminiferous tubules or pieces of testicular tissue. Recovery of undamaged spermatozoa from tubules or tissue requires mincing, squeezing, or vortexing the tissue, usually without the need of enzymatic digestion. A motility stimulant such as Pentoxifylline is commonly used to calculate the number of functionally competent spermatozoa. After recovery, spermatozoa may be used immediately for IVF-ICSI, incubated overnight prior to IVF-ICSI, or cryopreserved for future use. Methods for identifying, purifying, and determining the number and motility of spermatozoa during these processes are presented.
Collapse
|
12
|
Carpi A, Agarwal A, Sabanegh E, Todeschini G, Balercia G. Percutaneous biopsy of the testicle: a mini review with a proposal flow chart for non-obstructive azoospermia. Ann Med 2011; 43:83-9. [PMID: 21254902 DOI: 10.3109/07853890.2010.542173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A general consensus on the role of testicular biopsy in non-obstructive azoospermia (NOA) is needed. This paper reviews and updates technical aspects and clinical performance of the percutaneous testicular biopsy techniques, in particular large-needle aspiration biopsy (LNAB), and proposes a flow chart for the management of NOA. The English literature and original data were reviewed or analyzed. Large-needle biopsy (LNB) includes large-needle cutting biopsy (LNCB) and large-needle aspiration biopsy (LNAB). LNCB usually requires scrotal incision for the insertion of relatively large needles. Fine-needle aspiration biopsy (FNAB) does not require surgical equipment or expertise, employs the smallest needles (23- to 20-gauge), and permits sperm cytologic detection. LNAB also does not require surgical equipment or expertise, employs needles of size from 20- to 18-gauge, is safe, and can be used for testicular histology and sperm recovery. An operative flow chart is proposed for the management of NOA in which FNAB, LNAB and open surgical biopsy are used for the optimal management of NOA.
Collapse
Affiliation(s)
- Angelo Carpi
- Department of Reproduction and Ageing, University of Pisa, Pisa, Italy.
| | | | | | | | | |
Collapse
|
13
|
Carpi A, Sabanegh E, Mechanick J. Controversies in the management of nonobstructive azoospermia. Fertil Steril 2009; 91:963-70. [DOI: 10.1016/j.fertnstert.2009.01.083] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 01/12/2009] [Accepted: 01/16/2009] [Indexed: 02/06/2023]
|
14
|
Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007; 13:539-49. [PMID: 17895238 DOI: 10.1093/humupd/dmm029] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our objective was to establish which is the best sperm retrieval technique in non-obstructive azoospermia based on the available evidence. To date, no randomized controlled trial has compared the efficiency of these strategies and thus current recommendations are based on cumulative evidence provided by descriptive, observational and controlled studies. Three outcome measures were assessed for the sperm retrieval techniques: sperm retrieval rate (SRR), complications and live birth rate. Twenty-four descriptive studies reporting on the results of testicular sperm extraction (TESE) were encountered. Seven controlled studies that compared microdissection (MD) TESE with conventional TESE and seven controlled studies comparing fine needle testicular aspiration (FNA) with TESE were identified. The mean SRR for TESE was 49.5% (95% CI 49.0-49.9). TESE with multiple biopsies results in a higher SRR than FNA especially in cases of Sertoli-cell-only (SCO) syndrome and maturation arrest. Current evidence suggests that MD performs better than conventional TESE only in cases of SCO where tubules containing active focus of spermatogenesis can be identified. MD appears to be the safest technique regarding post-operative complications followed by FNA. Only three studies could be identified concerning the influence of the sperm retrieval technique on clinical pregnancy and live birth rate, hence no definitive conclusions can be made. However, so far there appears to be no impact of the technique itself on success rates.
Collapse
Affiliation(s)
- P Donoso
- Reproductive Medicine Unit, Clinica Alemana, Vitacura 5951, Santiago, Chile.
| | | | | |
Collapse
|
15
|
Schiff JD, Ramírez ML, Bar-Chama N. Medical and surgical management male infertility. Endocrinol Metab Clin North Am 2007; 36:313-31. [PMID: 17543721 DOI: 10.1016/j.ecl.2007.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Male infertility is the result of a variety of highly treatable conditions. The critical step in treating male infertility is to evaluate properly every male partner of an infertile couple and to generate the proper treatment strategy. There are many medical and surgical options that can help most couples overcome male factor infertility. Male infertility can most easily be broken down into problems of sperm production (testicular dysfunction) and problems of sperm transport (obstruction). When applicable, medical therapies are used as an initial strategy to improve sperm production or as a preliminary therapy to boost production transiently in anticipation of a surgical sperm retrieval attempt. A range of surgical options is available to correct varicoceles, reconstruct the obstructed system, or retrieve sperm for assisted reproduction.
Collapse
Affiliation(s)
- Jonathan D Schiff
- Department of Urology, Mount Sinai School of Medicine, Mount Sinai Medical Center, 1 Gustave L. Levy P., New York, NY 10029, USA.
| | | | | |
Collapse
|