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Surgical Management Techniques for Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Kevin C. Lewis, Scott Lundy, Sarah Vij
Complications of testicular sperm extraction include hematoma, infection, and damage to the testicular blood supply with resultant hypogonadism. Complications are rare among all sperm extraction procedures, with many studies reporting no complications [17,18,112]. mTESE, however, has been reported to have a lower rate of hematoma, testicular atrophy, and hypogonadism compared to standard TESE [18,19]. Hematoma and vascular injury in MESA and PESA procedures are similarly rare and may be lower for a MESA procedure with the use of the operative microscope and direct vision [19]. Vasal sperm aspiration carries a similar risk of hematoma, with the additional risk of vasal stenosis that is discussed in vasography.
Treatment Options: III. In Vitro Fertilization
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
In some cases of azoospermia, sperm are being produced but do not find their way to the ejaculate. This may be the result of an obstruction (e.g., previous vasectomy, infection), congenital absence of the vas deferens, or cases of severely impaired sperm production. In these cases, aspiration of epididymal sperm or testicular sperm by a urologist may be considered. In years past, the only way to aspirate epididymal sperm was via the microscopic epididymal sperm aspiration (MESA) procedure. This procedure is performed in the operating room under general anesthesia. More recently, the percutaneous epididymal sperm aspiration procedure has become more popular. It can be accomplished under local anesthesia in the office with a much shorter recuperation than the MESA procedure. If epididymal sperm aspiration does not produce viable sperm, then the urologist can resort to testicular sperm extraction. In all cases of sperm aspiration, the motility of the sample is quite poor; thus, the ICSI procedure must be performed. To accomplish this procedure, there must be coordination with the urologist and the IVF team. The sperm aspiration can be performed on the day of the oocyte recovery or before the IVF cycle and the samples are frozen.
Fertility preservation
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Men should be offered the opportunity to bank sperm before cancer treatment (Table 92.3). Spermache occurs at a median age of 13.4 (range 11.7–15.3) years. Post-pubertal males will ordinarily be capable of ejaculation and can provide sperm for storage. In males who cannot ejaculate or who are too young, electro-ejaculation, epididymal sperm aspiration or testicular sperm extraction may be performed. Cryopreserved material is usually stored for an initial period of 10 years; however, continued storage of cryopreserved sperm, beyond 10 years, should be offered to men who remain at risk of significant infertility. Testicular tissue cryopreservation from prepubescent males remains experimental.
Immunohistochemical examination of androgen receptor and estrogen receptor alpha expressions in obstructive and non-obstructive azoospermia
Published in Systems Biology in Reproductive Medicine, 2021
Yurdun Kuyucu, Gülfidan Coşkun, Dilek Şaker, Özdem Karaoğlan, İbrahim Ferhat Ürünsak, Volkan İzol, İbrahim Atilla Arıdoğan, Şeyda Erdoğan, Hülya Özgür, Sait Polat
Testicular sperm extraction procedures were performed by the urologist under local anesthesia. Testicular tissue specimens are placed in HEPES-buffered media (G-MOPS, Vitrolife) in sterile Petri dishes and minced using insulin injector needles. The products were placed in a tube and mixed 5–10 sec using a vortex-induced vibration system. Thereafter, fractions were searched for spermatozoa by the embryologist. Density gradient media at 90% and 50% density were prepared with sperm washing medium (G SPERM PLUS, Vitrolife) and sperm gradient medium (SpermGrad, Vitrolife). Semen added in density-gradient medium were centrifuged at 2500–3000 rpm for 20 min. Then the supernatant was removed gently and after the pellet was resuspended with 2 mL of sperm washing medium, it was centrifuged again at 2000 rpm for 10 min. Then, the sperm suspension was incubated at 37°C and was searched for spermatozoa. Testicular tissue specimens that were obtained by testicular sperm extraction procedures were prepared for advanced histopathological examination when no spermatozoa were detected.
Successful extraction of sperm cells after autologous bone marrow transplant: a case report
Published in Scandinavian Journal of Urology, 2019
Frederik M. Jacobsen, Mikkel Fode, Jens Sønksen, Dana A. Ohl, Christian Fuglesang S. Jensen
For the purpose of assisted reproduction, the patient underwent a microdissection testicular sperm extraction (m.T.E.S.E.). This procedure is carried out by making an equatorial incision in the tunica albuginea exposing the testicular tissue for microscopic examination. Under the operating microscope dilated seminiferous tubules (indicative of spermatogenesis) can be identified. Two such areas were identified deep in the superolateral part and superficial in the inferomedial part of the right testis. Biopsies from these areas showed several sperm cells. Random biopsies from the right testis was also performed but showed no sperm cells. Due to the positive finding of sperm cells it was decided not to continue on the left testis. The retrieved sperm cells were cryopreserved in 3.5 straws after the procedure. Testicular histology from the right testis demonstrated a sertoli cell only pattern in all tubules.
Biological therapy for non-obstructive azoospermia
Published in Expert Opinion on Biological Therapy, 2018
Sarah C. Vij, Edmund Sabanegh, Ashok Agarwal
Men with NOA have limited options for reproduction. Testicular sperm extraction with Intracytoplasmic Sperm Injection (ICSI) is possible in these patients, but it is expensive and associated with high morbidity in the female partner. If sperm cannot be retrieved by testicular sperm extraction, there are no current options to maintain the reproductive potential of these individuals. Therefore, there is significant clinical demand for alternate therapies for NOA that would allow the production of mature spermatozoa either using stem cells or by gene therapy for patients with idiopathic causes of infertility. Such a technique might allow for natural conception in a population that is otherwise relegated to assisted reproductive techniques. This review will cover three experimental approaches for restoring fertility in men with NOA: spermatogonial stem cell (SSC) transplantation, in vitro spermatogenesis using adult or embryonic pluripotent stem cells, and gene therapy.