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Jacob Rajfer - One of the best experts on this subject based on the ideXlab platform.

  • When is azooSpermia not azooSpermia
    Reviews in urology, 2008
    Co-Authors: Jacob Rajfer
    Abstract:

    Men with azooSpermia, defined as no Sperm in the ejaculate as documented by semen analysis, either have an obstruction to the excretory ductal system or defective Spermatogenesis. The observation that more than 60% of men with defective Spermatogenesis may have pockets of Spermatogenesis within the testis1,2 provides hope that many of these “azooSpermic” patients can potentially be fathers with Testicular Sperm extraction (TESE) or Testicular Sperm Aspiration (TESA) together with intracytoplasmic Sperm injection and in vitro fertilization, provided these “pockets” of Sperm, which theoretically never make it out of the ductal system, can be successfully harvested. TESE in these nonobstructive azooSpermic patients requires either the use of a microscope to find the Sperm (micro-TESE) or multiple incision sites in 1 or both testes in the search for these pockets of Sperm.3 TESA also requires multiple Aspirations in these azooSpermic patients, although the success rate with TESA may not be as high as with TESE.4,5 In addition, there is never any guarantee that any of these pockets of Sperm will be found when either of these 2 procedures is performed.

  • TESA or TESE: Which Is Better for Sperm Extraction?
    Reviews in urology, 2006
    Co-Authors: Jacob Rajfer
    Abstract:

    Many azooSpermic patients with nonobstructive azooSpermia (NOA) might be candidates for Sperm Aspiration as part of their in vitro fertilization procedure. Because Sperm might be present in some but not all parts of the testes of such men, multiple samplings of the Testicular tissue are usually performed to increase the probability of finding Sperm in NOA patients. These samplings can be done by 2 methods: 1) TESE (Testicular Sperm extraction), which is actually a surgical biopsy of the testis; or 2) TESA (Testicular Sperm Aspiration), which is performed by sticking a needle in the testis and aspirating fluid and tissue with negative pressure. Sperm extraction is being performed more and more by non-urologists (called andrologists) who are actually either internists or obstetrician-gynecologists. It stands to reason that these non-urologists prefer TESA, given that they are not surgically trained. There has always been debate, however, as to which procedure is “better” at obtaining Sperm for successful intracytoplasmic Sperm injection.

Edson Borges - One of the best experts on this subject based on the ideXlab platform.

  • Assisted reproductive technology outcomes in azooSpermic men: 10 years of experience with surgical Sperm retrieval.
    The aging male : the official journal of the International Society for the Study of the Aging Male, 2010
    Co-Authors: Luciana Semião Francisco, Daniela Paes De Almeida Ferreira Braga, Rita De Cássia Sávio Figueira, Camila Madaschi, Fabio F. Pasqualotto, Assumpto Iaconelli, Edson Borges
    Abstract:

    An azooSpermic man suffers from an absence of Sperm in the ejaculate and this condition is present in about 10% of infertile men. Obstructive azooSpermia (OA) is characterized by an occlusion or partial absence of the reproductive tract with the presence of normal Spermatogenesis. On the other hand, non-obstructive azooSpermia (NOA) is characterized by impaired Spermatogenesis. In these cases, Spermatozoa can be obtained by percutaneous epididymal or Testicular Sperm Aspiration (PESA and TESA, respectively) and used for intracytoplasmic injection (ICSI). To compare ICSI outcomes using Spermatozoa that were surgically retrieved by PESA and TESA, azooSpermic patients were divided into the following categories: (i) TESA-NOA (n = 102), (ii) TESA-OA (n = 103), and (iii) PESA-OA (n = 171). Fertilization, pregnancy, and implantation rates were compared between the groups. We noted a lower normal fertilization rate (p = 0.0017) and a higher abortion rate (p = 0.0387) among men in the TESA group who had OA when co...

  • Artificial oocyte activation with calcium ionophore A23187 in intracytoplasmic Sperm injection cycles using surgically retrieved Spermatozoa
    Fertility and sterility, 2008
    Co-Authors: Edson Borges, Daniela Paes De Almeida Ferreira Braga, Assumpto Iaconelli, T.c. Bonetti, Jose G. Franco
    Abstract:

    Objective To evaluate the effect of artificial oocyte activation (AOA) on intracytoplasmic Sperm injection (ICSI) cycles using surgically retrieved Sperm. Design Laboratory study. Setting Fertility/assisted fertilization center. Patient(s) Couples undergoing surgical Sperm retrieval for ICSI (n = 204). Intervention(s) Application of calcium ionophore A23187 for AOA. Main Outcome Measure(s) Cycles were divided into experimental groups according to the origin of the Sperm used for injection and the type of azooSpermia: [1] Testicular Sperm Aspiration in nonobstructive-azooSpermic patients (TESA-NOA group, n=58), [2] TESA in obstructive-azooSpermic patients (TESA-OA group, n=48), [3] and percutaneous epididymal Sperm Aspiration in obstructive-azooSpermic patients (PESA-OA, n=98). For each experimental group, cycles where AOA was applied (subgroup: activation) were compared with cycles in which AOA was not applied (subgroup: control). The fertilization, high-quality embryo, implantation, and pregnancy rates were compared among the subgroups. Result(s) For patients undergoing TESA, AOA did not improve ICSI outcomes for either type of azooSpermia. However, for cases in which the injected Sperm were retrieved from the epididymis, a statistically significantly increased rate of high-quality embryos was observed with AOA. Conclusion(s) Artificial oocyte activation may improve ICSI outcomes in azooSpermic patients when epididymal, but not Testicular Spermatozoa, are injected.

  • A comparison of post-thaw results between embryos arising from intracytoplasmic Sperm injection using surgically retrieved or ejaculated Spermatozoa.
    Fertility and sterility, 2008
    Co-Authors: Rita De Cássia Sávio Figueira, Camila Madaschi, Fabio F. Pasqualotto, Assumpto Iaconelli, Marcilio Nichi, D. Rodrigues, Edson Borges
    Abstract:

    Objective To study the effect of freeze–thaw on embryos derived from intracytoplasmic Sperm injection (ICSI) using surgically retrieved and ejaculated Spermatozoa. Design Retrospective study. Setting Private IVF center. Patient(s) Three hundred eighty-three patients undergoing frozen–thawed ET cycles. Intervention(s) Testicular Sperm Aspiration (TESA) or percutaneous epididymal Sperm Aspiration (PESA) were the Sperm surgical retrieval methods used for ICSI. Embryos resulting from ICSI using surgically retrieved and ejaculated Spermatozoa were frozen, thawed, and transferred. Main Outcome Measure(s) Post-thaw survival, implantation, and pregnancy rates. Result(s) No differences were found between the ejaculated Sperm and TESA/PESA groups in terms of post-thaw survival rate (68.4% vs. 66.1%, respectively), pregnancy rate (20.1% vs. 16.1%), and implantation rate (10.6% vs. 12.7%). Similar results were found for those variables when comparing TESA and PESA groups. Conclusion(s) Cleavage embryos arising from ICSI cycles using Testicular and epididymal Spermatozoa can be frozen with survival, pregnancy, and implantation rates comparable to those obtained with ejaculated Spermatozoa.

  • Etiology-specific outcomes of intracytoplasmic Sperm injection in azooSpermic patients.
    Fertility and sterility, 2005
    Co-Authors: Fabio F. Pasqualotto, Assumpto Iaconelli, Lia Mara Rossi, Valdemar Ortiz, Patricia Guilherme, Edson Borges
    Abstract:

    Objective To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic Sperm injection (ICSI) with epididymal or Testicular Spermatozoa from different types of azooSpermia. Design Retrospective study. Setting Academic medical center and private fertility center. Patient(s) Two hundred twelve patients underwent 257 ICSI cycles. Intervention(s) Cycles of ICSI were divided into four groups according to the etiology of azooSpermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular Sperm Aspiration and percutaneous epididymal Sperm Aspiration were the Sperm retrieval methods used for ICSI. Main outcome measure(s) Fertilization, pregnancy, and miscarriage rates. Result(s) Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). Conclusion(s) Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal Sperm was used compared with Testicular Sperm.

  • Sperm retrieval techniques in rats with suppressed Spermatogenesis by experimental cryptorchidism
    Human reproduction (Oxford England), 2004
    Co-Authors: Lia Mara Rossi, Fabio F. Pasqualotto, Assumpto Iaconelli, Luís A.v. Pereira, Luciana De Santis, Valdemar Ortiz, Edson Borges
    Abstract:

    OBJECTIVE: Our aim was to assess the suppression of Spermatogenesis and Sperm retrieval rate after Testicular Sperm extraction (TESE) or Testicular Sperm Aspiration (TESA) in adult rats with surgically induced cryptorchidism. METHODS: Adult rats were submitted to TESE and TESA procedures after 15 days of induced cryptorchidism. After Spermatozoa retrieval, the testicles were extracted, weighed and a morphological analysis by conventional light microscopy was done. The numbers of Spermatozoa retrieved in both TESA and TESE were rated and compared. RESULTS: Histological analysis of the testicles revealed Sertoli cell-only syndrome in 60% of the testicles, and maturation arrest in the remaining cryptorchid testicles. Significant differences were seen in the number of Spermatozoa retrieved ( P 0.05). CONCLUSIONS: It seems that a 15 day period of cryptorchidism is enough to induce Spermatogenesis disorders. No differences were detected in the number of Spermatozoa retrieved in the right or left testicles, irrespective of the Testicular pole. Furthermore, and even more importantly, no differences in the retrieval rate were seen between the two techniques.

Peter N. Schlegel - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of microdissection Testicular Sperm extraction, conventional Testicular Sperm extraction, and Testicular Sperm Aspiration for nonobstructive azooSpermia: a systematic review and meta-analysis
    Fertility and sterility, 2015
    Co-Authors: Aaron M. Bernie, Douglas A. Mata, Ranjith Ramasamy, Peter N. Schlegel
    Abstract:

    Objective To investigate the relative differences in outcomes among microdissection Testicular Sperm extraction (micro-TESE), conventional Testicular Sperm extraction (cTESE), and Testicular Sperm Aspiration (TESA) in men with nonobstructive azooSpermia. Design Systematic review and meta-analysis. Setting Outpatient academic and private urology clinics. Patients(s) Men with nonobstructive azooSpermia. Intervention(s) Micro-TESE, cTESE, or TESA. Main Outcome Measure(s) Sperm retrieval (SR). Result(s) Fifteen studies with a total of 1,890 patients were identified. The weighted average age of the patients was 34.4 years, the follicular stimulating hormone level was 20.5 mIU/mL, the T was 373 ng/dL, and the Testicular volume was 13.5 mL. In a direct comparison, performance of micro-TESE was 1.5 times more likely (95% confidence interval 1.4–1.6) to result in successful SR as compared with cTESE. Similarly, in a direct comparison, performance of cTESE was 2.0 times more likely (95% confidence interval 1.8–2.2) to result in successful SR as compared with TESA. Because of inconsistent reporting, evaluation of other procedural characteristics and pregnancy outcomes was not possible. Conclusion(s) Sperm retrieval was higher for micro-TESE compared with cTESE and for cTESE compared with TESA. Standardization of reported outcomes as well as combining all available SR data would help to further elucidate the SRs of these procedures.

Armand Zini - One of the best experts on this subject based on the ideXlab platform.

  • Sperm retrieval and intracytoplasmic Sperm injection outcomes with Testicular Sperm Aspiration in men with severe oligozooSpermia and cryptozooSpermia.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2020
    Co-Authors: Mohannad Alharbi, Ahmad Almarzouq, Armand Zini
    Abstract:

    INTRODUCTION Several studies addressed the role of Testicular Sperm Aspiration with intracytoplasmic Sperm injection (ICSI) in azooSpermic men but few have included non- azooSpermic men. The aim of this study was to evaluate Testicular Sperm Aspiration (TESA) Sperm retrieval rates and ICSI outcomes in men with severe oligozooSpermia. METHODS Data were collected retrospectively from 88 consecutive, non-azooSpermic, infertile men with idiopathic severe oligozooSpermia who underwent TESA between January 2011 and January 2018. Patients were categorized into four groups according to Sperm concentration: 1 million/ml (group 1), 0.1 million/ml (group 2),

  • Sperm retrieval and intracytoplasmic Sperm injection outcomes with Testicular Sperm Aspiration in men with severe oligozooSpermia and cryptozooSpermia
    Cuaj-canadian Urological Association Journal, 2020
    Co-Authors: Mohannad Alharbi, Ahmad Almarzouq, Armand Zini
    Abstract:

    INTRODUCTION Several studies addressed the role of Testicular Sperm Aspiration with intracytoplasmic Sperm injection (ICSI) in azooSpermic men but few have included non- azooSpermic men. The aim of this study was to evaluate Testicular Sperm Aspiration (TESA) Sperm retrieval rates and ICSI outcomes in men with severe oligozooSpermia. METHODS Data were collected retrospectively from 88 consecutive, non-azooSpermic, infertile men with idiopathic severe oligozooSpermia who underwent TESA between January 2011 and January 2018. Patients were categorized into four groups according to Sperm concentration: 1 million/ml (group 1), 0.1 million/ml (group 2), <0.1 million/ml (group 3) and cryptozooSpermia (group 4). RESULTS Mean male age was 37±7 years and the mean female age was 33±4 years. Sperm was recovered successfully in 90% (79/88) of the men overall and in 100% (30/30) of the men in group 1, 97% (29/30) of the men in group 2, 88% (15/17) of the men in group 3, and 45% (5/11) of the men in group 4. Most (65%, 57/88) of the couples had an embryo transfer (ET). The overall clinical pregnancy rate per ET was 46% (26/57). The clinical pregnancy rates (per ET) were 43% (9/21) in group 1, 65% (13/20) in group 2, 36% (4/11) in group 3 and 0% (0/5) in group 4. CONCLUSIONS Our data indicate TESA allows for high Sperm retrieval rates and acceptable ICSI pregnancy rates in men with severe oligozooSpermia. However, in our experience, TESA Sperm retrieval rates and ICSI outcomes are poor in cryptozooSpermic men.

  • Testicular Sperm Aspiration (TESA) for infertile couples with severe or complete asthenozooSpermia.
    Andrology, 2017
    Co-Authors: A. H. Al-malki, Khalid Alrabeeah, E. Mondou, V. Brochu-lafontaine, Simon J Phillips, Armand Zini
    Abstract:

    Summary The aim of the study was to evaluate reproductive outcomes in a cohort of infertile couples with severe and complete asthenozooSpermia undergoing TESA (Testicular Sperm Aspiration) with ICSI. We conducted a retrospective study of 28 couples with complete or severe asthenozooSpermia who underwent TESA between January 2010 and December 2015. We compared TESA-ICSI outcomes of these couples to ejaculate ICSI outcomes of 40 couples with severe asthenozooSpermia treated during the same time period at our institution. Couples with female factor infertility and/or female aged ≥39 were excluded. Sperm retrieval rates and ICSI outcomes [(MII oocytes, fertilization rate, good embryo rate (transferred and frozen), couples with embryo transfer (per cycle started), clinical pregnancy (per embryo transfer)] were recorded. Patients were grouped based on whether they had ejaculated (Ej-group) or Testicular (TESA-group) Spermatozoa used. Testicular Sperm patients were further classified based on whether they had complete asthenozooSpermia (0% total motility) (Tc-group) or severe asthenozooSpermia (≤1% progressive motility) (Ts-group). Mean (±SD) male and female ages were 36 ± 6 and 32 ± 4, respectively. Sperm recovery by Testicular Sperm Aspiration (TESA) was successful in 100% (28/28) of the men. The overall clinical pregnancy rate (CPR) per cycle started was 34% (23/68) with a mean of 1.1 ± 0.4 embryos transferred per transfer. Fertilization rates were significantly lower in TESA-group compared to Ej-group (52% vs. 67%, respectively; p = 0.001), while male age was significantly higher in TESA-group compared to Ej-group (34 ± 6 vs. 37 ± 6, respectively; p = 0.03). Moreover, female age was significantly higher in Tc-group compared to Ts-group (30 ± 4 vs. 33 ± 3, respectively; p = 0.0285). However, there were no significant difference in clinical pregnancy rate per embryo transfer in the Tc-group, Ts-group, and Ej-group (50% vs. 45% vs. 57%, respectively; p = 0.8219). The data suggest that Testicular Sperm-ICSI is no better than ejaculated Sperm-ICSI in couples with severe or complete asthenozooSpermia. Randomized, controlled trials comparing ejaculated vs. Testicular Spermatozoa are needed to assess the true benefit of TESA-ICSI in these couples.

  • Testicular Sperm Aspiration for nonazooSpermic men: Sperm retrieval and intracytoplasmic Sperm injection outcomes.
    Urology, 2014
    Co-Authors: Khalid Alrabeeah, Simon J Phillips, Faysal A. Yafi, Christine Flageole, Audrey Wachter, François Bissonnette, Isaac Jacques Kadoch, Armand Zini
    Abstract:

    Objective To evaluate Testicular Sperm Aspiration (TESA) Sperm retrieval rates and intracytoplasmic Sperm injection outcomes in nonazooSpermic men. Materials and Methods Data were collected retrospectively from 54 consecutive, nonazooSpermic, infertile men who underwent TESA between March 2007 and September 2012. Sperm retrieval rates and clinical pregnancy outcomes were recorded. Patients were subgrouped based on clinical diagnosis: group 1, anejaculation (primary, situational); group 2, idiopathic severe oligoasthenozooSpermia; and group 3, severe oligoasthenozooSpermia after vasovasostomy. Results Mean (±standard deviation) paternal and maternal ages were 39 ± 7 and 35 ± 5 years, respectively. Using TESA, Sperm recovery was successful in 94% (51 of 54) of the men overall and in 100% (17 of 17) of the men in group 1, 90% (28 of 31) in group 2, and 100% (6 of 6) in group 3. Overall, 35% of the couples achieved a clinical pregnancy using TESA Sperm (with a mean of 1.7 ± 0.9 embryos transferred per cycle). The clinical pregnancy rates were 40% in group 1, 33% in group 2, and 33% in group 3 with no significant difference in paternal or maternal age between groups. Conclusion The data indicate that TESA yields high Sperm retrieval rates in select groups of nonazooSpermic infertile men, and this approach results in acceptable pregnancy rates regardless of the male infertility etiology. Randomized controlled trials comparing ejaculated vs Testicular Sperm are needed to assess the true benefit of TESA-intracytoplasmic Sperm injection in these couples.

Sandro C. Esteves - One of the best experts on this subject based on the ideXlab platform.

  • Predictive model to estimate the chances of successful Sperm retrieval by Testicular Sperm Aspiration in patients with nonobstructive azooSpermia.
    Fertility and sterility, 2020
    Co-Authors: Ahmad Majzoub, Mohamed Arafa, Kareim Khalafalla, Sami Al-said, Hasan Burjaq, Moza Albader, Thoraya Al-marzooqi, Sandro C. Esteves, Haitham Elbardisi
    Abstract:

    Objective To explore predictors of successful Sperm retrieval (SR) and to identify potentially suitable candidates for Testicular Sperm Aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. Design Retrospective chart review. Setting Academic tertiary medical center. Patients A total of 297 patients with nonobstructive azooSpermia. Interventions All patients underwent full clinical evaluation before undergoing a staged SR procedure, starting with TESA and proceeding to microsurgical Testicular Sperm extraction (microTESE). Predictors of positive SR with TESA were selected using the least absolute shrinkage and selection operator (LASSO) regression analysis using k-fold cross-validation. The obtained regression coefficients were used to create a predictive model, and a receiver operating characteristic (ROC) curve was obtained to express its predictive ability. Cut-off values for each significant predictor were also identified using ROC analysis. Main outcome measure(s) Development of a prediction model for positive SR with TESA. Results Overall, a positive SR was observed in 23.6% of patients undergoing TESA. Average testis size (P = .017) and serum follicle-stimulating hormone (FSH) level (P 7.75 mL and serum FSH level Conclusions TESA may be a suitable alternative to microTESE in selected nonobstructive azooSpermia patients presenting with an average testis size >7.75 mL and serum FSH level

  • Development of treatment strategies in men with vulnerable Sperm.
    Translational Andrology and Urology, 2017
    Co-Authors: Ashok Agarwal, Sandro C. Esteves, Chak-lam Cho, Ahmad Majzoub
    Abstract:

    Dr. Samplaski, in her commentary, elegantly discussed different issues surrounding Sperm DNA fragmentation (SDF) (1) and the author largely endorsed the practice recommendations by Agarwal et al. (2). Firstly, she stated the drawbacks of routine semen analysis in the evaluation of male infertility supported by data from the LIFE study (3). This was followed by discussion of the testing methodologies. The author then further elaborated on interventions for mitigating high SDF and stressed on the use of antioxidant and Testicular Sperm as possible treatment strategies. Additional information on deleterious effects of cryopreservation on SDF was highlighted. Finally, the author summarized towards the end in last paragraph that “plan for an intracytoplasmic Sperm injection (ICSI) cycle with a fresh Testicular Sperm extraction (TESE)/Testicular Sperm Aspiration (TESA)” if SDF is persistently high even after correction of all reversible factors.

  • Microdissection Testicular Sperm Extraction (micro-TESE) as a Sperm Acquisition Method for Men with Nonobstructive AzooSpermia Seeking Fertility: Operative and Laboratory Aspects
    Sociedade Brasileira de Urologia, 2013
    Co-Authors: Sandro C. Esteves
    Abstract:

    Introduction Rare foci of Sperm production may be found in up to 60% of men with nonobstructive azooSpermia (NOA). Sperm production, if present, is minimal for Sperm appearance in the ejaculate. Given that there are no treatment options to restore fertility, Sperm retrieval is the only alternative to find Testicular Sperm than then can be used for in vitro fertilization (IVF). Among Sperm acquisition methods, micro-TESE has higher success rates at obtaining Sperm compared with Testicular Sperm extraction and Testicular Sperm Aspiration. Materials and Methods This video describes the operative aspects of micro-TESE, performed on an outpatient basis, in a man with NOA and history of cryptorchidism in whom orchidopexy was performed at age 6. The concept of micro-TESE is to identify areas of Sperm production within the testes with the aid of optical magnification (15-25X) and based on the size and appearance of the seminiferous tubules (ST). Conclusion Micro-TESE allowed the identification and extraction of Sperm-containing STs with minimum tissue excision and marked reduction in time processing of Testicular specimens for Sperm injection

  • Laboratory handling of epididymal and Testicular Spermatozoa: What can be done to improve Sperm injections outcome
    Journal of human reproductive sciences, 2012
    Co-Authors: Sandro C. Esteves, Alex C. Varghese
    Abstract:

    Spermatozoa from azooSpermic males can be retrieved from either the epididymis or the testis, depending on the type of azooSpermia, using different surgical methods such as percutaneous epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testicular Sperm extraction (TESE), and microsurgical Testicular Sperm extraction (micro- TESE). After collecting the epididymal fluid or Testicular tissue, laboratory techniques are used to remove contaminants, cellular debris, noxious microorganisms, and red blood cells. Processed Spermatozoa may be used for intracytoplasmic Sperm injection or eventually be cryopreserved. However, Spermatozoa collected from either the epididymis or the testis are often compromised and more fragile than ejaculated ones. Therefore, Sperm processing techniques should be used with great caution to avoid jeopardizing the Sperm fertilizing potential in treatment cycles. In this review, we describe the current methods for processing surgically-retrieved specimens, either fresh or frozen- thawed, and provide the tips and pitfalls for facilitating the handling of such specimens. In addition, we present the available laboratory tools to aid in the identification of viable immotile Spermatozoa to be used in conjunction with assisted reproductive techniques. Review of the literature was carried out using PubMed and Science Direct search engines.