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Chapter 14 - Obstructive Azoospermia: Is There a Place for Microsurgical Testicular Sperm Extraction?

Published online by Cambridge University Press:  24 May 2020

By
Ahmad Aboukhshaba ,
Russell P. Hayden  and
Peter N. Schlegel
Edited by
R. John Aitken ,
David Mortimer  and
Gabor Kovacs
R. John Aitken
Affiliation:
University of Newcastle, New South Wales
David Mortimer
Affiliation:
Oozoa Biomedical Inc, Vancouver
Gabor Kovacs
Affiliation:
Epworth Healthcare Melbourne
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Summary

Obstructive azoospermia (OA) is a common presenting condition of male infertility, resulting from either congenital or acquired blockage of the reproductive tract. Men facing a diagnosis of OA now have an array of treatment options, including definitive reconstruction and various forms of sperm retrieval. The optimum treatment decision for OA will depend on the goals, values, and expectations of the patient and his partner. In this review we will discuss the therapeutic approach to OA, stressing the requirement of a clear and thoughtful plan for staged intervention. Any proposed treatment strategy should optimize the chances of paternity while minimizing damage to the male genitourinary system. Special attention will be paid to the role of microdissection testicular sperm extraction (microTESE), as it is a useful and often underutilized rescue procedure for OA. Specifically, the advantages and disadvantages of microTESE will be evaluated, with particular focus on success rates and safety.

Type
Chapter
Information
Male and Sperm Factors that Maximize IVF Success , pp. 166 - 175
Publisher: Cambridge University Press
Print publication year: 2020

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References

Miyaoka, R. and Esteves, S. C. (2013) Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role? Clinics (Sao Paulo, Brazil) 68(Suppl 1):111–119.Google Scholar
Baker, K. and Sabanegh, E. Jr. (2013) Obstructive azoospermia: reconstructive techniques and results. Clinics (Sao Paulo, Brazil) 68(Suppl 1):61–73.Google Scholar
Bolduc, S., Fischer, M. A., Deceuninck, G. and Thabet, M. (2007) Factors predicting overall success: a review of 747 microsurgical vasovasostomies. Can Urol Assoc J /Journal de l’Association des urologues du Canada 1:388–394.CrossRefGoogle ScholarPubMed
Heidenreich, A., Altmann, P. and Engelmann, U. H. (2000) Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmic sperm injection. A cost-benefit analysis. Eur Urol 37:609–614.Google Scholar
Lee, R., Li, P. S., Goldstein, M., Tanrikut, C., Schattman, G., Schlegel, P. N. (2008) A decision analysis of treatments for obstructive azoospermia. Hum Reprod (Oxford, UK) 23:2043–2049.Google Scholar
Rumbold, A. R., Moore, V. M., Whitrow, M. J., Oswald, T. K., Moran, L. J., Fernandez, R. C., et al. (2017) The impact of specific fertility treatments on cognitive development in childhood and adolescence: a systematic review. Hum Reprod (Oxford, UK) 32:1489–1507.CrossRefGoogle ScholarPubMed
Farber, N. J., Flannigan, R., Li, P., Li, P. S. and Goldstein, M. (2018) The kinetics of sperm return and late failure following vasovasostomy or vasoepididymostomy: a systematic review. J Urol 201 241–250.CrossRefGoogle Scholar
ASRM (2008) Sperm retrieval for obstructive azoospermia. Fertil Steril 90:S213–218.CrossRefGoogle Scholar
van Wely, M., Barbey, N., Meissner, A., Repping, S. and Silber, S. J. (2015) Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference? Hum Reprod (Oxford, UK) 30:761–766.CrossRefGoogle ScholarPubMed
Esteves, S. C., Lee, W., Benjamin, D. J., Seol, B., Verza, S. Jr. and Agarwal, A. (2013) Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol 189:232–237.CrossRefGoogle Scholar
Steele, E. K., McClure, N., Maxwell, R. J. and Lewis, S. E. (1999) A comparison of DNA damage in testicular and proximal epididymal spermatozoa in obstructive azoospermia. Mol Hum Reprod 5:831–835.CrossRefGoogle ScholarPubMed
Westlander, G., Ekerhovd, E., Granberg, S., Lycke, N., Nilsson, L., Werner, C., et al. (2001) Serial ultrasonography, hormonal profile and antisperm antibody response after testicular sperm aspiration. Hum Reprod (Oxford, UK) 16:2621–2627.CrossRefGoogle ScholarPubMed
Schoor, R. A., Elhanbly, S., Niederberger, C. S. and Ross, L. S. (2002) The role of testicular biopsy in the modern management of male infertility. J Urol 167:197–200.CrossRefGoogle ScholarPubMed
Hung, A. J., King, P. and Schlegel, P. N. (2007) Uniform testicular maturation arrest: a unique subset of men with nonobstructive azoospermia. J Urol 178:608–612; discussion 612.Google Scholar
Tsai, M. C., Cheng, Y. S., Lin, T. Y., Yang, W. H. and Lin, Y. M. (2012) Clinical characteristics and reproductive outcomes in infertile men with testicular early and late maturation arrest. Urology 80:826–832.Google Scholar
Deruyver, Y., Vanderschueren, D. and Van der Aa, F. (2014) Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2:20–24.CrossRefGoogle ScholarPubMed
Okada, H., Dobashi, M., Yamazaki, T., Hara, I., Fujisawa, M., Arakawa, S., et al. (2002) Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 168:1063–1067.Google Scholar
Shufaro, Y., Prus, D., Laufer, N. and Simon, A. (2002) Impact of repeated testicular fine needle aspirations (TEFNA) and testicular sperm extraction (TESE) on the microscopic morphology of the testis: an animal model. Hum Reprod (Oxford, UK) 17:1795–1799.Google Scholar
Silber, S. J. (2000) Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod (Oxford, UK) 15:2278–2284.CrossRefGoogle ScholarPubMed
Zhu, Y. T., Hua, R., Quan, S., Tan, W. L., Chu, Q. J. and Wang, C. Y. (2018) Scrotal hemorrhage after testicular sperm aspiration may be associated with phosphodiesterase-5 inhibitor administration: a retrospective study. BMC Urology 18:8.CrossRefGoogle ScholarPubMed
Donoso, P., Tournaye, H. and Devroey, P. (2007) Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 13:539–549.CrossRefGoogle ScholarPubMed
Franco, G., Scarselli, F., Casciani, V., De Nunzio, C., Dente, D., Leonardo, C., et al. (2016) A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urology 16:20.Google Scholar
Alom, M., Ziegelmann, M., Savage, J., Miest, T., Kohler, T. S. and Trost, L. (2017) Office-based andrology and male infertility procedures-a cost-effective alternative. Trans Androl Urol 6:761–772.CrossRefGoogle ScholarPubMed
Schlegel, P. N. and Su, L. M. (1997) Physiological consequences of testicular sperm extraction. Hum Reprod (Oxford, UK) 12:1688–1692.CrossRefGoogle ScholarPubMed
Schlegel, P. N. (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod (Oxford, UK) 14:131–135.Google Scholar
Amer, M., Ateyah, A., Hany, R. and Zohdy, W. (2000) Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Hum Reprod (Oxford, UK) 15:653–656.Google Scholar
Eliveld, J., van Wely, M., Meissner, A., Repping, S., van der Veen, F. and van Pelt, A. M. M. (2018) The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Hum Reprod Update 24:442–454.CrossRefGoogle ScholarPubMed

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