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Majzoub A, Viana MC, Achermann APP, Ferreira IT, Laursen RJ, Humaidan P, Esteves SC. Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring. J Clin Med 2024; 13:4939. [PMID: 39201081 PMCID: PMC11355217 DOI: 10.3390/jcm13164939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This review summarizes the chances of success with ICSI for NOA patients and examines preoperative factors and laboratory techniques associated with positive outcomes. Furthermore, we reviewed possible consequences for offspring by the use of ICSI with testicular sperm retrieved from NOA patients and the interventions that could potentially mitigate risks. Testicular sperm retrieved from NOA patients may exhibit increased chromosomal abnormalities, and although lower fertilization and pregnancy rates are reported in NOA patients compared to other forms of infertility, the available evidence does not suggest a significant increase in miscarriage rate, congenital malformation, or developmental delay in their offspring compared to the offspring of patients with less severe forms of infertility or the offspring of fertile men. However, due to limited data, NOA patients should receive specialized reproductive care and personalized management. Counseling of NOA patients is essential before initiating any fertility enhancement treatment not only to mitigate health risks associated with NOA but also to enhance the chances of successful outcomes and minimize possible risks to the offspring.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha 3050, Qatar;
- Department of Clinical Urology, Weill Cornell Medicine-Qatar, Doha 3050, Qatar
| | - Marina C. Viana
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
| | - Arnold P. P. Achermann
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
| | - Isadora T. Ferreira
- Faculty of Medical Sciences, Pontifical Catholic University of Campinas, Campinas 13087-571, SP, Brazil;
| | - Rita J. Laursen
- Skive Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark; (R.J.L.); (P.H.)
| | - Peter Humaidan
- Skive Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark; (R.J.L.); (P.H.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Sandro C. Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Surgery, Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
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Arasteh H, Gilani MAS, Ramezani-Binabaj M, Babaei M. Microdissection testicular sperm extraction outcomes in azoospermic patients with bilateral orchidopexy. Andrology 2024; 12:157-163. [PMID: 37210678 DOI: 10.1111/andr.13463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cryptorchidism is considered to be one of the most common causes of non-obstructive azoospermia. There are several surgical techniques to retrieve sperm in these patients. Microdissection testicular sperm extraction (m-TESE) is a recent sperm retrieval technique which is considered to be a safe, non-blind, and feasible method. OBJECTIVES This study aimed to investigate sperm retrieval rate (SRR) by the mTESE method in patients who have undergone orchidopexy due to bilateral cryptorchidism. MATERIALS AND METHODS In this retrospective study, 56 ex-cryptorchid patients, who underwent mTESE due to post orchidopexy azoospermia, were included. Patients with hypogonadotropic hypogonadism, Klinefelter syndrome, azoospermia factors (AZF) microdeletion, or chromosomal translocation were excluded from the study. Data were obtained from medical files. RESULTS SRR in this study was 46%. Patients were divided into two groups of negative (n = 30) and positive (n = 26) based on the sperm extraction outcomes. There was no statistically significant difference between two groups regarding the mean age at mTESE, mean age at orchidopexy, testicular size, and serum testosterone concentration. However, testicular location, histological patterns, FSH, and LH level showed to have statistically significant relation with sperm retrieval results. But, according to our logistic regression, none of the included variable in the model including FSH, LH, histopathology, and testis location have a significant effect on the presence of the sperm. DISCUSSION In the present study, SRR was significantly higher in patients with scrotal testis and low level of FSH and LH. CONCLUSIONS Performing mTESE could be recommended in ex-cryptorchid patients with post orchidopexy NOA. Preoperative testicular biopsy seems to be unnecessary while clinical criteria can perfectly define NOA.
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Affiliation(s)
- Hamid Arasteh
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
- Department of Urology, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
- Department of Urology, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Ramezani-Binabaj
- Department of Urology, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Babaei
- Department of Urology, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Xu S, Huang Y, Yao C, Li P, Zhi E, Chen W, Deng C, Zhao F, Li Z, Tian R. Stepwise mini-incision microdissection testicular sperm extraction in NOA patients with a history of cryptorchidism: a case-control study. Basic Clin Androl 2023; 33:21. [PMID: 37587426 PMCID: PMC10433673 DOI: 10.1186/s12610-023-00196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/13/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Although the orchiopexy is recommended for cryptorchidism to preserve male fertility, non-obstructive azoospermia (NOA) may occur in adulthood. Fortunately, a great many of azoospermic men may obtain sperm by microdissection testicular sperm extraction (mTESE). Due to the potential injuries caused by testicular diagnostic biopsy and vascular damage at the time of orchidopexy, minimal invasiveness is particularly important during mTESE, aims to reduce the surgical damage and avoids secondary testicular failure. This comparative study aims to investigate the efficacy of stepwise mini-incision mTESE technique by comparison with standard mTESE in the treatment of NOA patients with a history of cryptorchidism. RESULTS A total of 73 mTESE procedures were divided into two groups: Group 1 included 37 cases performed by stepwise mini-incision mTESE, while Group 2 included 36 cases with standard mTESE. The overall sperm retrieval rate (SRR) in the two groups was 68.5% (50/73), with no significant difference in SRR between Group 1 (78.4%, 29/37) and Group 2 (58.3%, 21/36) (P = 0.1). In addition, 46.0% of the patients (17/37) obtained sperm in the first mini-incision step in Group 1, which was also equal to an overall SRR in Group 2 (58.3%, 21/36) (P = 0.3). The operation time in Group 1 (72.6 ± 33.9 min) was significantly shorter than that in Group 2 (90.4 ± 36.4 min) (P = 0.04). Patients with an orchidopexy age no more than 10 years old had a higher SRR (79.5%, 31/39) than others (55.9%, 19/34) (P = 0.03). There were no postoperative complications including wound infection, scrotal hematoma, persistent pain, and testicular atrophy during a follow-up period of at least 6 months. CONCLUSIONS In conclusion, our study suggests that the stepwise mini-incision mTESE could be a promising approach for sperm retrieval in NOA men with a history of cryptorchidism. While the technique may potentially reduce operation time and surgical invasiveness, further research is needed to validate these findings on a larger scale. The results also suggest that age at orchidopexy may affect SRR and have important implications for the management of cryptorchidism.
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Affiliation(s)
- Shuai Xu
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhua Huang
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Yao
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Li
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erlei Zhi
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cunzhong Deng
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fujun Zhao
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Li
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ruhui Tian
- Department of Andrology, Center for Men's Health, Department of ART, Institute of Urology, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Wang Z, Wang X, Song C, Lu F, Zhai J, Li N, Jiang B, Tan S, Xuan X. The pregnancy outcomes in patients with epididymal obstructive azoospermia after microsurgical vasoepididymostomy: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1186729. [PMID: 37275372 PMCID: PMC10233013 DOI: 10.3389/fmed.2023.1186729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose Pregnancy outcomes (overall patency rate, overall pregnancy rate, natural pregnancy rate, and the ratio of patients with pregnancy by assisted reproductive technology) after microsurgical vasoepididymostomy (MVE) in patients with epididymal obstructive azoospermia (EOA) were assessed through meta-analysis. Method We searched PubMed, Embase, Web of Science, and the Cochrane Library databases up to 28 September 2022 for published literature related to retrospective or prospective clinical studies of obstructive azoospermia after apparent microsurgical vasoepididymostomy. Our search terms included obstructive azoospermia, epididymis obstruction, epididymal obstruction and vasoepididymostomy, and epididymovasostomy. Two researchers independently performed the literature search and assessed the eligibility of selected studies according to established inclusion criteria. The meta-analysis was performed using RevMan 5.4 software. Result A total of 504 patients with EOA were included in 10 studies (including 2 prospective clinical studies and 8 retrospective clinical studies). The mean patency rate after MVE was 72% (95% CI 68-76%). The overall pregnancy rate was 34% (95% CI 30-38%). The natural pregnancy rate is 21% (95% CI 17-24%). The ratio of patients with pregnancy by assisted reproductive technology (ART) was 34.9%. For the factors affecting pregnancy outcomes after MVE, the overall pregnancy rates in patients receiving bilateral MVE were significantly higher than those receiving unilateral MVE (75.4 vs. 24.6%). The mean best sperm count and sperm motility in patients with overall pregnancy were significantly higher than those with failing pregnancies. For the subgroup meta-analysis of microsurgical vasoepididymostomy, there were no statistically significant differences in the overall patency rate (68 vs. 70%), the overall pregnancy rate (33 vs. 37%), the natural pregnancy rate (20 vs. 23%), the ratio of ART (30 vs. 28%) in end-to-side or end-to-end anastomosis, and longitudinal or triangular intussusception MVE. Conclusion Vasectomy patency rates are higher, but natural pregnancy rates are lower in EOA male infertility patients after MVE. Altering the MVE procedures alone does not significantly improve pregnancy outcomes, but ART after MVE could improve the chance of pregnancy regardless of sperm parameters. We recommended that human sperms from EOA male infertility patients should be cryopreserved during intraoperative MVE for application in the subsequent ICSI treatment procedure.
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Affiliation(s)
- Zilong Wang
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xinkun Wang
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Changze Song
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Fuding Lu
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiawen Zhai
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Naifa Li
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Baohong Jiang
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Senbao Tan
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xujun Xuan
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Cheeloo College of Medicine, Shandong University, Jinan, China
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Kim SW, Lee J, Lee TH, Kim DS, Song SH, Kim DK. Azoospermic Men with a History of Cryptorchidism Treated by Orchiopexy Have Favorable Outcomes after Testicular Sperm Extraction: A Systematic Review and Meta-Analysis. World J Mens Health 2023; 41:81-93. [PMID: 35274507 PMCID: PMC9826915 DOI: 10.5534/wjmh.210198] [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: 09/26/2021] [Revised: 12/12/2021] [Accepted: 12/19/2021] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis investigated the sperm retrieval rate (SRR) and pregnancy rate after testicular sperm extraction in men with azoospermia and those with a history of cryptorchidism treated by orchiopexy. MATERIALS AND METHODS The SRR and clinical pregnancy rate were investigated. We performed a sub-analysis that included factors such as bilaterality, age, and idiopathic non-obstructive azoospermia (iNOA). The analysis comprised 13 studies from January 1995 to July 2021. The data sources were PubMed/MEDLINE, Embase, and the Cochrane Library included "cryptorchidism", "orchidopexy", "azoospermia", and "testicular sperm extraction". RESULTS The overall mean SRR was 63.3% (95% confidence interval [CI], 57.6%-68.6%; I²=62.4%), and the overall mean clinical pregnancy rate was 30.1% (95% CI, 22.6%-38.8%; I²=69.9%). The meta-analysis comparing the SRR, there was no significant difference between patients with a history of bilateral and unilateral orchiopexy (relative risk [RR]=1.02; 95% CI, 0.89-1.16; p=0.79). Orchiopexy performed under the age of 10 years showed significantly increased SRR compared to the age of over 10 years (RR=1.25; 95% CI, 1.06-1.47; p=0.008). Azoospermic men with a history of cryptorchidism treated by orchiopexy had significantly higher SRR than iNOA (RR=1.90; 95% CI, 1.40-2.58; p<0.0001). CONCLUSIONS Men with azoospermia and a history of cryptorchidism treated by orchiopexy had significantly higher SRR than those with iNOA after testicular sperm extraction. Furthermore, patients who underwent orchiopexy before the age of ten years had significantly higher SRR than patients operated at an older than the age of ten years.
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Affiliation(s)
- Sang Woon Kim
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Seung-Hun Song
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Korea
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Non-invasive Molecular Biomarkers for Predicting Outcomes of Micro-TESE in Patients with Idiopathic Non-obstructive Azoospermia. Expert Rev Mol Med 2022; 24:e22. [PMID: 35659383 DOI: 10.1017/erm.2022.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fertility of Cryptorchid Testis-An Unsolved Mistery. Genes (Basel) 2021; 12:genes12121894. [PMID: 34946843 PMCID: PMC8700981 DOI: 10.3390/genes12121894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 01/21/2023] Open
Abstract
Cryptorchidism (undescended testis) is one of the most common diagnoses in the pediatric urologist office. Even in the modern era, there still are a lot of debates regarding the optimal time for surgery related to the expected results in relation with the testicular function, including fertility. The review below intends to clarify issues regarding the impact of cryptorchidism on testicular histology and function, semen analysis, the relation between hormonal and surgical treatment, future fertility, and paternity rate.
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Saber-Khalaf M, Ali AF, Elsoghier OM. Predictive factors of successful testicular sperm extraction for non-obstructive azoospermia with a history of bilateral cryptorchidism and normal testosterone. Andrologia 2021; 54:e14284. [PMID: 34664297 DOI: 10.1111/and.14284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022] Open
Abstract
This study aimed to assess the predictive factors of successful sperm retrieval in non-obstructive azoospermia with a history of bilateral cryptorchidism. This retrospective study included 103 patients with azoospermia who had micro-dissection testicular sperm extraction between January 2010 and January 2020. The median (range) age of the patients and their wives in the study group was 33 (21-44) and 24 (19-33) years, respectively. The patients with low testosterone level (<3 ng/dl) were prescribed with human chorionic gonadotropin 5,000 IU injection every 3 days for 3 months. Those with persistent low testosterone even after hormonal stimulation were excluded. Sperms were retrieved from 64 (62%) patients, whilst failed in 39 (38%) patients. On univariate analysis, the median testicular volume was significantly larger in the successful group versus the failed group (p < .001), serum FSH and serum LH were significantly lower in the successful group (p = .001), serum testosterone was significantly higher in the successful group compared to the failed group (p < .001) and the age of orchidopexy was lower in the successful group versus the failed group (p = .016). On multivariate analysis, the average testicular volume and the serum testosterone levels were independent factors for successful sperm retrieval.
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Affiliation(s)
- Mohammed Saber-Khalaf
- Department of Urology, Sohag University Hospital, Faculty of medicine, Sohag University, Sohag, Egypt
| | - Atef F Ali
- Department of Urology, South Valley University, Qena, Egypt
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Kang C, Punjani N, Schlegel PN. Reproductive Chances of Men with Azoospermia Due to Spermatogenic Dysfunction. J Clin Med 2021; 10:jcm10071400. [PMID: 33807489 PMCID: PMC8036343 DOI: 10.3390/jcm10071400] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/31/2022] Open
Abstract
Non-obstructive azoospermia (NOA), or lack of sperm in the ejaculate due to spermatogenic dysfunction, is the most severe form of infertility. Men with this form of infertility should be evaluated prior to treatment, as there are various underlying etiologies for NOA. While a significant proportion of NOA men have idiopathic spermatogenic dysfunction, known etiologies including genetic disorders, hormonal anomalies, structural abnormalities, chemotherapy or radiation treatment, infection and inflammation may substantively affect the prognosis for successful treatment. Despite the underlying etiology for NOA, most of these infertile men are candidates for surgical sperm retrieval and subsequent use in intracytoplasmic sperm injection (ICSI). In this review, we describe common etiologies of NOA and clinical outcomes following surgical sperm retrieval and ICSI.
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Li P, Yao CC, Zhi EL, Xu Y, Wan Z, Jiang YC, Huang YH, Gong YH, Chen HX, Tian RH, Yang C, Zhao LY, Li Z. Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia. J Zhejiang Univ Sci B 2020; 21:87-92. [PMID: 31898445 DOI: 10.1631/jzus.b1900232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-obstructive azoospermia (NOA), which is defined as the absence of spermatozoa in the ejaculate secondary to impaired spermatogenesis within the testis, may be caused by a variety of etiologies, including varicocele-induced testicular damage, cryptorchidism, prior testicular torsion, post-pubertal mumps orchitis, gonadotoxic effects from medications, genetic abnormalities, chemotherapy/radiation, and other unknown causes currently classified as idiopathic (Cocuzza et al., 2013). The microdissection testicular sperm extraction (micro-TESE) technique involves a meticulous microsurgical exploration of the testicular parenchyma to identify and selectively extract larger seminiferous tubules that carry a higher probability of complete spermatogenesis (Schlegel, 1999). The Cornell group evaluated the efficacy of micro-TESE in 152 NOA patients with an associated history of cryptorchidism. In their series, spermatozoa were successfully retrieved in 116/181 attempts (64%), and the resulting pregnancy rate was 50% with a delivery rate of 38% (Dabaja and Schlegel, 2013). Franco et al. (2016) described a stepwise micro-TESE approach in NOA patients, which was considered to reduce the cost, time, and effort associated with the surgery. Alrabeeah et al. (2016) further reported that a mini-incision micro-TESE, carried through a 1-cm equatorial testicular incision, can be useful for micro-TESE candidates, particularly in patients with cryptozoospermia. We conducted a retrospective study of 20 consecutive NOA patients with a history of orchidopexy from May 2015 to March 2017.
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Affiliation(s)
- Peng Li
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,Department of Urology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
| | - Chen-Cheng Yao
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Er-Lei Zhi
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yuan Xu
- Reproductive Medicine Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Zhong Wan
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Ying-Chuan Jiang
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,Department of Urology, Zhoushan Hospital, Zhoushan 316021, China
| | - Yu-Hua Huang
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yue-Hua Gong
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Hui-Xing Chen
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Ru-Hui Tian
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Chao Yang
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Liang-Yu Zhao
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Zheng Li
- Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,Reproductive Medicine Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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Emad-Eldin S, Abdelaziz O, Shokr M. Spigelian-cryptorchidism syndrome in an adult male complaining of primary infertility: Case report. Andrologia 2020; 53:e13838. [PMID: 33099792 DOI: 10.1111/and.13838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
History of cryptorchidism is present in about 10% of infertile patients seeking medical help, whereas 20% of them are azoospermic. Most of the patients with bilateral cryptorchidism have a low testicular volume and high serum FSH level. Ectopic testes are present only in 5% of the patients with cryptorchidism. The anterior abdominal wall is a rare site for ectopic testis where Spigelian hernia is usually accompanied. We present a case of bilateral ectopic anterior abdominal wall testes associated with Spigelian hernia on the left side.
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Affiliation(s)
- Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University Hospitals, Cairo, Egypt
| | - Omar Abdelaziz
- Department of Diagnostic and Intervention Radiology, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Shokr
- Department of Andrology, Cairo University Hospitals, Cairo, Egypt
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Barbotin AL, Dauvergne A, Dumont A, Ramdane N, Mitchell V, Rigot JM, Boitrelle F, Robin G. Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes. Asian J Androl 2020; 21:445-451. [PMID: 30880688 PMCID: PMC6732891 DOI: 10.4103/aja.aja_2_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l−1vs 19.3 IU l−1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.
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Affiliation(s)
- Anne-Laure Barbotin
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Anaïs Dauvergne
- CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Agathe Dumont
- CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Nassima Ramdane
- CHU Lille, Department of Biostatistics, EA2694, Lille University, F-59000 Lille, France
| | - Valérie Mitchell
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Jean-Marc Rigot
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Florence Boitrelle
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303 Poissy, France
| | - Geoffroy Robin
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France.,CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
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13
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Osaka A, Iwahata T, Kobori Y, Shimomura Y, Yoshikawa N, Onota S, Yamamoto A, Ide H, Sugimoto K, Okada H. Testicular volume in non-obstructive azoospermia with a history of bilateral cryptorchidism may predict successful sperm retrieval by testicular sperm extraction. Reprod Med Biol 2020; 19:372-377. [PMID: 33071639 PMCID: PMC7542013 DOI: 10.1002/rmb2.12338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/14/2020] [Accepted: 06/27/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Cryptorchidism is one of the most common causes of non‐obstructive azoospermia (NOA) in adulthood. Even if early orchidopexy is performed to preserve fertility potential, some patients still suffer from azoospermia. Fertility potential is significantly lower in bilateral than unilateral cryptorchidism. The aims of this study were to identify clinical parameters that predict the likely success of sperm recovery by microscopic testicular sperm extraction (micro‐TESE) and also the likely outcome of intracytoplasmic sperm injection using sperm from NOA patients who submitted to bilateral orchidopexy. Methods Fifty‐two NOA patients with a history of bilateral cryptorchidism underwent micro‐TESE. The following clinical parameters were evaluated as predictive factors for successful sperm recovery: age at micro‐TESE; age at orchidopexy; period from orchidopexy to micro‐TESE; luteinizing hormone (LH); follicle‐stimulating hormone (FSH); testosterone; average testicular volume; and body mass index. Results In the successful sperm retrieval group, average testicular volume was significantly greater, while serum LH and FSH, and body mass index were significantly lower. In a multivariate analysis, average testicular volume was positively correlated with successful sperm recovery. Conclusion Our results indicate that testicular volume in NOA patients with bilateral cryptorchidism is a predictor for successful sperm recovery.
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Affiliation(s)
- Akiyoshi Osaka
- Department of Urology Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Toshiyuki Iwahata
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Yoshitomo Kobori
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Yukihito Shimomura
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Naoki Yoshikawa
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Shin Onota
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Atsushi Yamamoto
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hisamitsu Ide
- Department of Urology Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Kouhei Sugimoto
- Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hiroshi Okada
- Department of Urology Dokkyo Medical University Saitama Medical Center Koshigaya Japan.,Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
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14
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Ortac M, Cilesiz NC, Demirelli E, Aydin R, Savun M, Ermec B, Kadioglu A. Undescended Testis Does Not Affect the Outcome of Microdissection Testicular Sperm Extraction. Urology 2020; 141:77-81. [DOI: 10.1016/j.urology.2020.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/05/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
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15
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Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, Fusco F, Kadioglou A, Kliesch S, Kopa Z, Krausz C, Pelliccione F, Pizzocaro A, Rassweiler J, Verze P, Vignozzi L, Weidner W, Maggi M, Sofikitis N. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:733-757. [PMID: 31665451 DOI: 10.1093/humupd/dmz028] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factor affecting sperm retrieval rate (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) have not been systematically evaluated. In addition, although micro-TESE (mTESE) has been advocated as the gold standard for sperm retrieval in men with NOA, its superiority over conventional TESE (cTESE) remains conflicting. OBJECTIVE AND RATIONALE The objective was to perform a meta-analysis of the currently available studies comparing the techniques of sperm retrieval and to identify clinical and biochemical factors predicting SRR in men with NOA. In addition, PRs and live birth rates (LBRs), as derived from subjects with NOA post-ICSI, were also analysed as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR derived from cTESE or mTESE in patients with NOA and their specific determinants were included. Data derived from genetic causes of NOA or testicular sperm aspiration were excluded. OUTCOMES Out of 1236 studies, 117 studies met the inclusion criteria for this study, enrolling 21 404 patients with a mean age (± SD) of 35.0 ± 2.7 years. cTESE and mTESE were used in 56 and 43 studies, respectively. In addition, 10 studies used a mixed approach and 8 studies compared cTESE with mTESE approach. Overall, a SRR per TESE procedure of 47[45;49]% (mean percentage [95% CI]) was found. No differences were observed when mTESE was compared to cTESE (46[43;49]% for cTESE versus 46[42;49]% for mTESE). Meta-regression analysis demonstrated that SRR per cycle was independent of age and hormonal parameters at enrolment. However, the SRR increased as a function of testis volume. In particular, by applying ROC curve analysis, a mean testis volume higher than 12.5 ml predicted SRR >60% with an accuracy of 86.2% ± 0.01. In addition, SRR decreased as a function of the number of Klinefelter's syndrome cases included (S = -0.02[-0.04;-0.01]; P < 0.01. I = 0.12[-0.05;0.29]; P = 0.16). Information on fertility outcomes after ICSI was available in 42 studies. Overall, a total of 1096 biochemical pregnancies were reported (cumulative PR = 29[25;32]% per ICSI cycle). A similar rate was observed when LBR was analysed (569 live births with a cumulative LBR = 24[20;28]% per ICSI cycle). No influence of male and female age, mean testis volume or hormonal parameters on both PR and LBR per ICSI cycle was observed. Finally, a higher PR per ICSI cycle was observed when the use of fresh sperm was compared to cryopreserved sperm (PR = 35[30;40]%, versus 20[13;29]% respectively): however, this result was not confirmed when cumulative LBR per ICSI cycle was analysed (LBR = 30[20;41]% for fresh versus 20[12;31]% for cryopreserved sperm). WIDER IMPLICATIONS This analysis shows that cTESE/mTESE in subjects with NOA results in SRRs of up to 50%, with no differences when cTESE was compared to mTESE. Retrieved sperms resulted in a LBR of up to 28% ICSI cycle. Although no difference between techniques was found, to conclusively clarify if one technique is superior to the other, there is a need for a sufficiently powered and well-designed randomized controlled trial to compare mTESE to cTESE in men with NOA.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Endocrinology Unit, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Carlo Bettocchi
- Department of Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Gert Dohle
- Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ates Kadioglou
- Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology (CeRA), Münster University Hospital (UKM), Münster, Germany
| | - Zsolt Kopa
- Andrology Centre, Department of Urology Semmelweis University, Budapest, Hungary
| | - Csilla Krausz
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Fiore Pelliccione
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Alessandro Pizzocaro
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Center IRCCS, Rozzano, Milan, Italy
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - Paolo Verze
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
| | - Mario Maggi
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
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16
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Ozan T, Karakeci A, Kaplancan T, Pirincci N, Firdolas F, Orhan I. Are predictive factors in sperm retrieval and pregnancy rates present in nonobstructive azoospermia patients by microdissection testicular sperm extraction on testicle with a history of orchidopexy operation? Andrologia 2019; 51:e13430. [DOI: 10.1111/and.13430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/02/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tunc Ozan
- Department for Urology Firat University Medical Faculty Elazig Turkey
| | - Ahmet Karakeci
- Department for Urology Firat University Medical Faculty Elazig Turkey
| | - Tansel Kaplancan
- Department for Assisted Reproductive Techniques Momart Clinic Istanbul Turkey
| | - Necip Pirincci
- Department for Urology Firat University Medical Faculty Elazig Turkey
| | - Fatih Firdolas
- Department for Urology Firat University Medical Faculty Elazig Turkey
| | - Irfan Orhan
- Department for Urology Firat University Medical Faculty Elazig Turkey
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17
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Duong HQ, Tang VKH, Liperis G, Khoa LD. Orchidopexy Results in the Recovery of Sperm in the Ejaculate of a Non-obstructive Azoospermic Adult with Bilateral Cryptorchidism — A Case Report. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cryptorchidism or undescended testis is one of the most common pediatric disorders of the male endocrine glands and the most typical congenital abnormality identified at birth. Bilateral cryptorchidism is frequently associated with azoospermia and male infertility. The standard therapy is the surgical repositioning of the testes (orchidopexy) within the scrotal sac after the age of six months to eighteen months. Current findings suggest that no sperm is recovered in the ejaculate, for patients with bilateral cryptorchidism, when the mean age at the time of orchidopexy is around 16 years and above. Here we report an unusual case of an adult patient with bilateral cryptorchidism and non-obstructive azoospermia for which orchidopexy resulted in the recovery of sperm in the ejaculate, improving his options for future fertility treatment.
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Affiliation(s)
- Huy Quang Duong
- Department of Andrology, Au Co Hospital, Bien Hoa City, Vietnam
| | | | - Georgios Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW 2145, Australia
| | - Le Dang Khoa
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
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18
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Ragab MW, Cremers JF, Zitzmann M, Nieschlag E, Kliesch S, Rohayem J. A history of undescended testes in young men with Klinefelter syndrome does not reduce the chances for successful microsurgical testicular sperm extraction. Andrology 2018; 6:525-531. [DOI: 10.1111/andr.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. W. Ragab
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
- Department of Clinical and Surgical Andrology; Cairo University; Cairo Egypt
| | - J.-F. Cremers
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - M. Zitzmann
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - E. Nieschlag
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - S. Kliesch
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - J. Rohayem
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
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19
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Cito G, Della Camera PA, Degli Innocenti S, Coccia ME, Nesi G, Cocci A, Morselli S, Minervini A, Carini M, Serni M, Gacci M, Natali A. Testicular sperm extraction after laparoscopic orchiectomy for bilateral postpubertal intra-abdominal cryptorchidism: What chance of sperm retrieval? Andrologia 2017; 50. [DOI: 10.1111/and.12936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- G. Cito
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - P. A. Della Camera
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - S. Degli Innocenti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; Careggi Hospital; University of Florence; Florence Italy
| | - M. E. Coccia
- Department of Obstetrics and Gynecology; Careggi Hospital; University of Florence; Florence Italy
| | - G. Nesi
- Department of Human Pathology and Oncology; Careggi Hospital; University of Florence; Florence Italy
| | - A. Cocci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - S. Morselli
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - A. Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. Carini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. Serni
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. Gacci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - A. Natali
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
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20
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Cissen M, Meijerink AM, D'Hauwers KW, Meissner A, van der Weide N, Mochtar MH, de Melker AA, Ramos L, Repping S, Braat DDM, Fleischer K, van Wely M. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2016; 31:1934-41. [PMID: 27406950 DOI: 10.1093/humrep/dew147] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/02/2016] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Can an externally validated model, based on biological variables, be developed to predict successful sperm retrieval with testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA) using a large nationwide cohort? SUMMARY ANSWER Our prediction model including six variables was able to make a good distinction between men with a good chance and men with a poor chance of obtaining spermatozoa with TESE. WHAT IS KNOWN ALREADY Using ICSI in combination with TESE even men suffering from NOA are able to father their own biological child. Only in approximately half of the patients with NOA can testicular sperm be retrieved successfully. The few models that have been developed to predict the chance of obtaining spermatozoa with TESE were based on small datasets and none of them have been validated externally. STUDY DESIGN, SIZE, DURATION We performed a retrospective nationwide cohort study. Data from 1371 TESE procedures were collected between June 2007 and June 2015 in the two fertility centres. PARTICIPANTS/MATERIALS, SETTING, METHODS All men with NOA undergoing their first TESE procedure as part of a fertility treatment were included. The primary end-point was the presence of one or more spermatozoa (regardless of their motility) in the testicular biopsies.We constructed a model for the prediction of successful sperm retrieval, using univariable and multivariable binary logistic regression analysis and the dataset from one centre. This model was then validated using the dataset from the other centre. The area under the receiver-operating characteristic curve (AUC) was calculated and model calibration was assessed. MAIN RESULTS AND THE ROLE OF CHANCE There were 599 (43.7%) successful sperm retrievals after a first TESE procedure. The prediction model, built after multivariable logistic regression analysis, demonstrated that higher male age, higher levels of serum testosterone and lower levels of FSH and LH were predictive for successful sperm retrieval. Diagnosis of idiopathic NOA and the presence of an azoospermia factor c gene deletion were predictive for unsuccessful sperm retrieval. The AUC was 0.69 (95% confidence interval (CI): 0.66-0.72). The difference between the mean observed chance and the mean predicted chance was <2.0% in all groups, indicating good calibration. In validation, the model had moderate discriminative capacity (AUC 0.65, 95% CI: 0.62-0.72) and moderate calibration: the predicted probability never differed by more than 9.2% of the mean observed probability. LIMITATIONS, REASONS FOR CAUTION The percentage of men with Klinefelter syndrome among men diagnosed with NOA is expected to be higher than in our study population, which is a potential selection bias. The ability of the sperm retrieved to fertilize an oocyte and produce a live birth was not tested. WIDER IMPLICATIONS OF THE FINDINGS This model can help in clinical decision-making in men with NOA by reliably predicting the chance of obtaining spermatozoa with TESE. STUDY FUNDING/COMPETING INTEREST This study was partly supported by an unconditional grant from Merck Serono (to D.D.M.B. and K.F.) and by the Department of Obstetrics and Gynaecology of Radboud University Medical Center, Nijmegen, The Netherlands, the Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands, and the Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Merck Serono had no influence in concept, design nor elaboration of this study. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- M Cissen
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - A M Meijerink
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - K W D'Hauwers
- Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A Meissner
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands Department of Urology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - N van der Weide
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - A A de Melker
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - L Ramos
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S Repping
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
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21
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Ashraf MC, Singh S, Raj D, Ramakrishnan S, Esteves SC. Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India. J Hum Reprod Sci 2013; 6:111-23. [PMID: 24082652 PMCID: PMC3778600 DOI: 10.4103/0974-1208.117175] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/13/2013] [Accepted: 06/11/2013] [Indexed: 11/24/2022] Open
Abstract
CONTEXT: Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results. AIMS: We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR. SETTINGS AND DESIGN: Case series of men with NOA treated in a tertiary healthcare center. MATERIALS AND METHODS: An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes. STATISTICAL ANALYSIS: Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR. RESULTS: The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%. CONCLUSIONS: We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.
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Abstract
This article summarizes the current literature regarding azoospermia caused by spermatogenic failure. The causes and genetic contributions to spermatogenic failure are reviewed. Medical therapies including use of hormonal manipulation, whether guided by a specific abnormality or empiric, to induce spermatogenesis are discussed. The role of surgical therapy, including a discussion of varicocelectomy in men with spermatogenic failure, as well as an in-depth review of surgical sperm retrieval with testicular sperm extraction and microdissection testicular sperm extraction, is provided. Finally, future directions of treatment for men with spermatogenic failure are discussed, namely, stem cell and gene therapy.
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Affiliation(s)
- Boback M Berookhim
- Department of Urology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA; Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Gul U, Turunc T, Haydardedeoglu B, Yaycioglu O, Kuzgunbay B, Ozkardes H. Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience. Andrology 2012; 1:47-51. [PMID: 23258629 DOI: 10.1111/j.2047-2927.2012.00003.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 11/28/2022]
Abstract
We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli-cell-only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non-obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.
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Affiliation(s)
- U Gul
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey.
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Irkilata HC, Kibar Y, Basal S, Kurt B, Gunal A, Alp BF, Oral E, Musabak U, Tahmaz L, Dayanc M. The impact of simple orchiectomy on semen quality and endocrine parameters in postpubertal cryptorchid men. Int Urol Nephrol 2012; 44:1617-22. [PMID: 22865396 DOI: 10.1007/s11255-012-0256-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
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Merchant R, Gandhi G, Allahbadia GN. In vitro fertilization/intracytoplasmic sperm injection for male infertility. Indian J Urol 2011; 27:121-32. [PMID: 21716935 PMCID: PMC3114573 DOI: 10.4103/0970-1591.78430] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Progress in the field of assisted reproduction, and particularly micromanipulation, now heralds a new era in the management of severe male factor infertility, not amenable to medical or surgical correction. By overcoming natural barriers to conception, in vitro fertilization and embryo transfer (IVF-ET), subzonal sperm insemination, partial zona dissection, and intracytoplasmatic injection of sperm (ICSI) now offer couples considered irreversibly infertile, the option of parenting a genetically related child. However, unlike IVF, which necessitates an optimal sperm number and function to successfully complete the sequence of events leading to fertilization, micromanipulation techniques, such as ICSI, involving the direct injection of a spermatozoon into the oocyte, obviate all these requirements and may be used to alleviate severe male factor infertility due to the lack of sperm in the ejaculate due to severely impaired spermatogenesis (non-obstructive azoospermia) or non-reconstructable reproductive tract obstruction (obstructive azoospermia). ICSI may be performed with fresh or cryopreserved ejaculate sperm where available, microsurgically extracted epididymal or testicular sperm with satisfactory fertilization, clinical pregnancy, and ongoing pregnancy rates. However, despite a lack of consensus regarding the genetic implications of ICSI or the application and efficacy of preimplantation genetic diagnosis prior to assisted reproductive technology (ART), the widespread use of ICSI, increasing evidence of the involvement of genetic factors in male infertility and the potential risk of transmission of genetic disorders to the offspring, generate major concerns with regard to the safety of the technique, necessitating a thorough genetic evaluation of the couple, classification of infertility and adequate counseling of the implications and associated risks prior to embarking on the procedure. The objective of this review is to highlight the indications, advantages, limitations, outcomes, implications and safety of using IVF/ICSI for male factor infertility to enable a more judicious use of these techniques and maximize their potential benefits while minimizing foreseen complications.
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Affiliation(s)
- Rubina Merchant
- Deccan Fertility Clinic, Rotunda - Center for Human Reproduction, Mumbai, India
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Fedder J. History of cryptorchidism and ejaculate volume as simple predictors for the presence of testicular sperm. Syst Biol Reprod Med 2011; 57:154-61. [DOI: 10.3109/19396368.2010.550796] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gupta S, Agarwal A, Sharma R, Ahmady A. Recovery, Preparation, Storage and Utilization of Spermatozoa for Fertility Preservation in Cancer Patients and Sub-Fertile Men. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/205891581000100204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sperm cryopreservation is an important part of an infertility program for patients undergoing infertility treatments, fertility assurance for vasectomy cases, and for fertility preservation due to cancer or other medical conditions. With recent developments in reproductive technology, even men with severely impaired sperm parameters can benefit from cryopreservation as procedures such as intra-cytoplasmic sperm injection (ICSI) require only a few sperm to achieve fertilization and pregnancy. The increasing success of cancer treatment and concerted efforts to ensure quality of life after successful treatment have placed great emphasis on the need to preserve the reproductive capability of young men. It is a highly effective method of protecting male fertility potential, and involves collection, freezing, and long-term storage of sperm. Based on the etiological condition of the patients, sperm can be collected by ejaculation or by surgical retrieval from epididymis or testes. The option to bank sperm should be offered systematically to all patients who may benefit. However, this is not a standard of practice yet; it may be overlooked due to lack of physician awareness regarding the need for fertility preservation and the effectiveness of this option, and/or overestimating the limitations of poor baseline sperm quality leading physician to view cryopreservation as futile. Failure to offer cryopreservation ignores the only possible reproductive option available to certain patients.
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Affiliation(s)
- Sajal Gupta
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Reecha Sharma
- Centre for Reproductive Medicine, Glickman Urological & Kidney Institute, & Obstetrics and Gynaecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Ahmady
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
- MacDonald IVF and Fertility program, University Hospitals Case Medical Centre, Cleveland, OH
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Plotton I, Brosse A, Lejeune H. Faut-il modifier la prise en charge du syndrome de Klinefelter pour améliorer les chances de paternité ? ANNALES D'ENDOCRINOLOGIE 2010; 71:494-504. [DOI: 10.1016/j.ando.2010.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 06/25/2010] [Accepted: 06/29/2010] [Indexed: 01/27/2023]
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Abstract
Hypogonadotropic hypogonadism (HH), consequent to congenital or acquired disorders of the hypothalamic-pituitary axis, presents as absent/delayed/arrested sexual maturation and infertility. Optimal management includes: (a) confirmation of the diagnosis and prognosis, (b) timing and choice of therapeutic intervention and (c) consideration of future fertility prospects. Therapy is usually initiated with testosterone to induce development of secondary sexual characteristics, taking the patient (often diagnosed late) through puberty. Monitoring of the impact of the condition on long-term health and psychosocial function is necessary. Treatment is likely to be life-long, requiring regular monitoring for its optimization and avoidance of adverse responses. Induction of spermatogenesis requires either pulsatile gonadotropin releasing hormone (GnRH) or gonadotropin administration. Gonadotropins can be self-administered subcutaneously and are not inferior to the more costly GnRH. 'Reversible genetic hypogonadotropic hypogonadism' is a recently described entity which has implications for the long-term management of patients with HH.
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Affiliation(s)
- T S Han
- Centre for Neuroendocrinology, University College London Medical School, Royal Free Hospital, Hampstead, London NW3 2PF, UK
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Gambera L, Governini L, De Leo V, Luddi A, Morgante G, Tallis V, Piomboni P. Successful multiple pregnancy achieved after transfer of frozen embryos obtained via intracytoplasmic sperm injection with testicular sperm from an AZFc-deleted man. Fertil Steril 2010; 94:2330.e1-3. [PMID: 20447624 DOI: 10.1016/j.fertnstert.2010.03.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 03/29/2010] [Accepted: 03/29/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a case of successful triplet pregnancy after testicular sperm extraction (TESE) from a man with AZFc deletion and intracytoplasmic sperm injection (ICSI). DESIGN Case report. SETTING University hospital. PATIENT(S) A 38-year-old man affected by complete AZFc deletion and azoospermia. INTERVENTION(S) Spermiogram, Y-chromosome microdeletion screening, TESE for sperm recovery from testicular tissue on the same day as ICSI, transfer of frozen-thawed embryos, vaginal ultrasound examination. MAIN OUTCOME MEASURE(S) The Y chromosome genetic status of an azoospermic patient who underwent TESE and ICSI, the fertilization and pregnancy outcome. RESULT(S) The patient was found to be azoospermic, and the deletion screening showed complete AZFc deletion. After TESE, the recovered testicular sperm were selected for ICSI. Three good quality embryos were obtained and were frozen due to ovarian hyperstimulation syndrome in the female partner. After transfer of the thawed embryos, a triplet pregnancy was diagnosed by vaginal ultrasonography at the seventh week of gestation. Two male and one female healthy babies were born. CONCLUSION(S) This is the first report of a successful triplet pregnancy after the transfer of frozen-thawed embryos in a couple in whom the male partner was azoospermic and a carrier of complete AZFc deletion. This deletion should not adversely affect a man's TESE retrieval prognosis or the fertilization, cleavage, and implantation of embryos. The offspring were healthy, although the two sons inherited the AZFc deletion.
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Affiliation(s)
- Laura Gambera
- Center for the Diagnosis and Treatment of Couple Sterility, Siena Hospital, University of Siena, Siena, Italy
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Haimov-Kochman R, Prus D, Farchat M, Bdolah Y, Hurwitz A. Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques. ACTA ACUST UNITED AC 2009; 33:e139-43. [PMID: 19622071 DOI: 10.1111/j.1365-2605.2009.00977.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aetiology of cryptorchidism is still undiscernible in the majority of cases. It has long been argued that cryptorchidism reflects a primary testicular maldevelopment, where the contralateral scrotal testis also suffers from aspermatogenesis and low spermatogonia count. The aim of the study was to determine the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy after testicular sperm extraction (TESE) and intracytoplasmatic sperm injection (ICSI). In a retrospective analysis, we compared the sperm retrieval, fertilization, pregnancy and live birth rates after ICSI of consecutive ex-cryptorchid azoospermic patients (n = 15) undergoing TESE between Jan 2000 and Dec 2007 vs. non-cryptorchid azoospermic men (n = 142). Sperm retrieval rate of ex-cryptorchid men by TESE (66%) was comparable with non-cryptorchid men (47%) (p = 0.15) despite significantly higher FSH levels (30.7 +/- 25.4 vs. 17.9 +/- 14.8 respectively) (p = 0.018) and a more prevalent histopathology diagnosis of aspermatogenesis (75% vs. 40%, p = 0.046). Fertilization (43.3%), pregnancy (30%) and live birth (20%) rates after TESE-IVF-ICSI in the ex-cryptorchid group were not different from the non-cryptorchid group (48.7, 43 and 29%, p = 0.26, p = 0.21, p = 0.29 respectively). We conclude that the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy employing TESE-IVF-ICSI is comparable with non-cryptorchid azoospermic men.
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Affiliation(s)
- R Haimov-Kochman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
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Male and female factors that influence ICSI outcome in azoospermia or aspermia. Reprod Biomed Online 2009; 18:168-76. [DOI: 10.1016/s1472-6483(10)60252-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Harris SE, Sandlow JI. Sperm acquisition in nonobstructive azoospermia: what are the options? Urol Clin North Am 2008; 35:235-42, ix. [PMID: 18423244 DOI: 10.1016/j.ucl.2008.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Approximately 10% of male-factor infertility is caused by azoospermia, and nearly two thirds of these patients have nonobstructive azoospermia (NOA). As experience has been gained, increasing numbers of men who have NOA are having sperm retrieved from their testes and used for intracytoplasmic sperm injection with vitro fertilization. This article reviews the various sperm retrieval techniques, discussing the advantages and disadvantages and the outcomes of each. Predictive factors for sperm retrieval are presented, as are some of the controversies that exist regarding sperm acquisition in NOA.
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Affiliation(s)
- Stephanie E Harris
- Department of Urology, Medical College of Wisconsin, 9200 West Wisconsin Ave., Milwaukee, WI 53226, USA
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Marcelli F, Robin G, Lefebvre-Khalil V, Marchetti C, Lemaitre L, Mitchell V, Rigot JM. [Results of surgical testicular sperm extractions (TESE) in a population of azoospermic patients with a history of cryptorchidism based on a 10-year experience of 142 patients]. Prog Urol 2008; 18:657-62. [PMID: 18971109 DOI: 10.1016/j.purol.2008.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 04/17/2008] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cryptorchidism is a common and possible etiology of male infertility. OBJECTIVES This is a retrospective study of 142 azoospermic men with history of cryptorchidism. A testicular sperm extraction (TESE) was performed for each of them, between 1995 and 2005, to realize in vitro fecundation with intracytoplasmic sperm injection (ICSI). MATERIAL AND METHODS We studied the clinical pattern (age at the treatment, unilateral or bilateral cryptorchidism), hormonal levels (total testosterone and FSH) and ultrasound examinations in this population. Then, we studied the rates of successful TESE according to these various characteristics. RESULTS The main origin of azoospermia is non obstructive (secretory). A great majority of the patients (71.8%) has benefited of an orchidopexy before the age of 10 years which does not seem to represent a factor of better forecast of surgical extraction of sperm cells. In the subgroup of the bilateral cryptorchidy, the rate of extraction was 63% (55/87). In the subgroup of the one-sided cryptorchidy, it was 61.9% (36/42). CONCLUSION For us, history of cryptorchidism is an etiology of good prognosis for azoospermia, since the rate of TESE with positive sperm retrieval is 65%. In our population, the subgroups of patients whose FSH is normal and/or whose testicular volume is higher than 10 cm3 are those whose forecast is still better, because the rate of TESE with positive sperm retrieval is 75%.
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Affiliation(s)
- F Marcelli
- Service d'andrologie, hôpital Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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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.
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Affiliation(s)
- P Donoso
- Reproductive Medicine Unit, Clinica Alemana, Vitacura 5951, Santiago, Chile.
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Amer M, Zohdy W, Abd El Naser T, Hosny H, Arafa M, Fakhry E. Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia. Fertil Steril 2007; 89:592-6. [PMID: 17517404 DOI: 10.1016/j.fertnstert.2007.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to measure the diameter of seminiferous tubules (ST) during microdissection testicular sperm extraction (TESE) using a micrometer fixed to one of the eyepieces of the operating microscope to find a correlation between the extracted ST diameter and TESE outcome. DESIGN A prospective comparative study. SETTING Adam International Andrology and Infertility Clinic, Giza, Egypt. PATIENT(S) Two hundred sixty-four patients with nonobstructive azoospermia (NOA) were included. INTERVENTION(S) Patients underwent TESE using the open surgical technique. The STs were measured using the micrometer, and the tubule with the largest diameter was excised and freshly examined under an inverted microscope. If no spermatozoa were found, another sample was taken from the second most dilated tubule area and then at random until sperm were found or a maximum six samples were harvested. If no spermatozoa were detected, the contralateral testis was operated upon. MAIN OUTCOME MEASURE(S) The TESE outcome in relation to ST diameter. RESULT(S) The total sperm recovery rate was 105 out of 264 (39.8%). When ST measured >or=300 microm the sperm retrieval rate was 16 out of 19 (84.2%). When ST diameter was <300 microm, the sperm retrieval rate was 36.3% (89 out of 245). CONCLUSION(S) During microdissection TESE, the best cutoff level of the ST diameter for harvesting testicular spermatoza is 110 microm with sensitivity 86.0% and specificity 74.4% (AUC 0.653, 95% confidence interval 0.608-0.663). When ST diameter is 300 microm or more a single tubule biopsy is usually sufficient to harvest enough testicular spermatozoa for intracytoplasmic sperm injection or sperm freezing with minimal tissue excision.
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Affiliation(s)
- Medhat Amer
- Department of Andrology, Faculty of Medicine, Kaser El Aini, Cairo University Hospital, Cairo, Egypt
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Herwig R, Tosun K, Schuster A, Rehder P, Glodny B, Wildt L, Illmensee K, Pinggera GM. Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction. Fertil Steril 2007; 87:1071-6. [DOI: 10.1016/j.fertnstert.2006.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 10/02/2006] [Accepted: 10/11/2006] [Indexed: 11/15/2022]
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Irkilata HC, Dayanc M, Yildirim I, Cincik M, Aydur E, Peker AF. Low sperm recovery from the undescended testis with testicular sperm extraction in postpubertal cryptorchids: preliminary report. Andrologia 2005; 37:65-8. [PMID: 16026426 DOI: 10.1111/j.1439-0272.2005.00655.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
As postpubertal cryptorchid testes are generally atrophic and have high malignancy risk, orchiectomy is recommended as the treatment method. However, a few case reports advocated orchiopexy due to finding sperm afterwards. The present clinical study aimed at determining the possibility of finding spermatozoa in postpubertal cryptorchid testis with testicular sperm extraction (TESE). Initially testicular biopsy and later TESE was performed in the undescended testis of 22 unilateral postpubertal cryptorchids and in one of the testes of three bilateral postpubertal cryptorchids. Histopathological assessment of testicular biopsy specimen showed that three patients had maturation arrest and 22 had seminiferous tubular atrophy. By TESE, spermatozoa were found in only one specimen of 25 testes. Our results show that the expectancy to find spermatozoa in postpubertal cryptorchid testis is extremely low by current sperm recovery methods and orchiectomy is still the accurate method of treatment.
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Affiliation(s)
- H C Irkilata
- Maresal Cakmak Military Hospital, Erzurum, Turkey.
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40
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Stouffs K, Lissens W, Tournaye H, Van Steirteghem A, Liebaers I. The choice and outcome of the fertility treatment of 38 couples in whom the male partner has a Yq microdeletion. Hum Reprod 2005; 20:1887-96. [PMID: 15790609 DOI: 10.1093/humrep/deh847] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with Yq microdeletions may suffer from fertility problems. The purpose of this study was to assess the outcome of the fertility treatment of these patients. METHODS For 38 patients with Yq microdeletions, data were collected about medical history, karyotype, testicular histopathology and the presence of spermatozoa in the ejaculate or testicular biopsies. RESULTS Sixteen patients with an azoospermia factor region c (AZFc) deletion had at least one cycle with ICSI. The clinical pregnancy outcome was 22% per embryo transfer. Three babies have been born and two pregnancies are ongoing. Sex selection for female embryos in combination with ICSI in order to prevent the transmission of the fertility problems was discussed with 14 couples; eight were in favour of the selection. In addition, eight couples made the decision to use donor sperm because ICSI was impossible or objectionable and, in this group of patients, a total of nine babies were born. CONCLUSIONS Despite the improvement of assisted reproductive technology, ICSI could be offered only to patients with an AZFc deletion. Insemination with donor sperm is a potential alternative for other patients.
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Affiliation(s)
- Katrien Stouffs
- Centre for Medical Genetics, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
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