REPRODUCTIVE ANDROLOGY SURGERY WORKSHOP III 17-21 January 2016 – Reproductive Medicine Unit – Jahra Hospital KUWAIT CLINICAL MANAGEMENT OF MEN WITH NONOBSTRUCTIVE AZOOSPERMIA Lesson 4: Sperm Retrieval Methods Dr Sandro ESTEVES Medical and Scientific Director ANDROFERT - Andrology & Human Reproduction Clinic Campinas, Brazil
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Clinical management of men with nonobstructive azoospermia - Sperm Retrieval Methods
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REPRODUCTIVE ANDROLOGY SURGERY WORKSHOP III 17-21 January 2016 – Reproductive Medicine Unit – Jahra Hospital
KUWAIT
CLINICAL MANAGEMENT OF MEN WITH NONOBSTRUCTIVE AZOOSPERMIA Lesson 4: Sperm Retrieval Methods
Dr Sandro ESTEVES Medical and Scientific Director ANDROFERT - Andrology & Human Reproduction Clinic Campinas, Brazil
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2016
ANDROFERT
Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83
About 40-50% of men with SF have residual spermatogenesis within the testis
§ Not enough for sperm to appear in ejaculate
§ 600-800 seminiferous tubules § Goal is identify site of
production and retrieve sperm for ICSI
§ Geographic location unpredictable
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 3 2016
ANDROFERT
Op#ons for sperm retrieval in spermatogenic failure
Esteves et al Int Braz J Urol 2013;37:570-‐83; Deruyver et al Andrology 2014;2:20-‐4
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 4 2016
ANDROFERT
A threshold of 3 mature sperma#ds per seminiferous tubule’s cross-‐ sec#on must be exceeded in order for spermatozoa to spill over into the ejaculate. Men with NOA have a mean of 0–3 mature sperma#ds per seminiferous tubule, thus explaining why rare sperm are occasionally found in ejaculates
Semen Analysis at Day of Sperm Retrieval
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2016
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 15 2016
ANDROFERT
Microdissection TESE – Postop. • 100 men with NOA • Controlled trial of TESE v. Microdissection • Serial ultrasound follow-up at 1, 3, 6 mo.
Std TESE Microdissection
Sperm retrieval 30% 47%
Acute changes 48% 15%
Chronic changes 58% 3%
Amer et al., Hum Reprod 15:653, 2000
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 16 2016
ANDROFERT
Okada et al.: Microdissection TESE Std TESE Microdissection
Retrieval rate: SCO 6.3% 34%
Retrieval rate: All NOA pts 16.7% 45%
Ultrasound changes 51% 12%
Complications* 7.5% 2.5%
Okada et al., J Urology 168:1063, 2002
*Decreased tesQcular volume seen a[er 25% of TESE procedures
Repeat micro-‐TESE a^er an ini#ally successful procedure can be carried out, but should be delayed for at least 6 months due to inflammatory changes. SR success is markedly lower (25% vs 80%) if repeat micro-‐ TESE is performed within 6 months of the first opera#on.
Repeat Micro-TESE
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 18 2016
ANDROFERT
Schlegel PN, Su LM. Physiological consequences of tes#cular sperm extrac#on. Hum Reprod 1997; 12: 1688–92.
Key Messages – Day 4 Sperm Retrieval Methods
ANDROFERTANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 19 2016
ANDROFERT
Requires use of microscope (15-25x) Depends on differential size of tubules Tedious Learning curve
ü Increased sperm yield ü Less tissue removal ü Fewer postoperative changes
Thank you
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