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Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?

Men presenting with non-obstructive azoospermia are the most challenging clinical scenario for an infertile couple. Intracytoplasmic Sperm Injection (ICSI) with testicular sperm retrieval gave a chance for biological fatherhood once sperm can be found, but unfortunately sperm recovery rate (SSR) is...

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Autores principales: Vieira, Marcelo, Bispo de Andrade, Marcos Alécio, Santana-Santos, Eduesley
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580663/
https://www.ncbi.nlm.nih.gov/pubmed/36303631
http://dx.doi.org/10.3389/frph.2022.980824
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author Vieira, Marcelo
Bispo de Andrade, Marcos Alécio
Santana-Santos, Eduesley
author_facet Vieira, Marcelo
Bispo de Andrade, Marcos Alécio
Santana-Santos, Eduesley
author_sort Vieira, Marcelo
collection PubMed
description Men presenting with non-obstructive azoospermia are the most challenging clinical scenario for an infertile couple. Intracytoplasmic Sperm Injection (ICSI) with testicular sperm retrieval gave a chance for biological fatherhood once sperm can be found, but unfortunately sperm recovery rate (SSR) is something near 50%, leading to a discussion about what surgical retrieval technique is the best. Historically sperm have been retrieved using conventional Testicular Sperm Extraction (c-TESE), Testicular Sperm Aspiration (TESA), a combination of Testicular Fine Needle Aspiration (TfNA)/c-TESE, Testicular Microdissection (TM) and Open Testicular Mapping (OTEM). c-TESE published in 1995 by Devroey and cols. consists of testis delivery, a large unique albuginea incision and extraction of a portion from the majority of testicular tubules. TESA published in 1996 by Lewin and cols. is done percutaneously using a 21–23 gauge needle and a syringe to aspire testicular tubules. TfNA was published in 1965 by Obrant and Persson as an aspiration biopsy and cytological exam to verify sperm production. In 1999 Turek and cols. published the use of TfNA combined with c-TESE for sperm retrieval. In 1999, Peter Schlegel published a technique using a microsurgical approach to identify more probable sperm production areas inside the testicle that could be excised with better precision and less tissue. OTEM is a multiple biopsy approach, published in 2020 by Vieira and cols., based on TfNA principles but done at the same time without albuginea opening or surgical microscope need. Since Testicular Microdissection publication, the method became the gold standard for sperm retrieval, allowing superior SSR with minimal tissue removal, but the amount of testicular dissection to find more probable spermatogenesis areas, difficulties in comparative design studies, diversity TM results among doctors and other methods that can achieve very similar results we question TM superiority. The objective is review existing literature and discuss advantages and disadvantages of all the methods for sperm retrieval in non-obstructive azoospermia.
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spelling pubmed-95806632022-10-26 Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men? Vieira, Marcelo Bispo de Andrade, Marcos Alécio Santana-Santos, Eduesley Front Reprod Health Reproductive Health Men presenting with non-obstructive azoospermia are the most challenging clinical scenario for an infertile couple. Intracytoplasmic Sperm Injection (ICSI) with testicular sperm retrieval gave a chance for biological fatherhood once sperm can be found, but unfortunately sperm recovery rate (SSR) is something near 50%, leading to a discussion about what surgical retrieval technique is the best. Historically sperm have been retrieved using conventional Testicular Sperm Extraction (c-TESE), Testicular Sperm Aspiration (TESA), a combination of Testicular Fine Needle Aspiration (TfNA)/c-TESE, Testicular Microdissection (TM) and Open Testicular Mapping (OTEM). c-TESE published in 1995 by Devroey and cols. consists of testis delivery, a large unique albuginea incision and extraction of a portion from the majority of testicular tubules. TESA published in 1996 by Lewin and cols. is done percutaneously using a 21–23 gauge needle and a syringe to aspire testicular tubules. TfNA was published in 1965 by Obrant and Persson as an aspiration biopsy and cytological exam to verify sperm production. In 1999 Turek and cols. published the use of TfNA combined with c-TESE for sperm retrieval. In 1999, Peter Schlegel published a technique using a microsurgical approach to identify more probable sperm production areas inside the testicle that could be excised with better precision and less tissue. OTEM is a multiple biopsy approach, published in 2020 by Vieira and cols., based on TfNA principles but done at the same time without albuginea opening or surgical microscope need. Since Testicular Microdissection publication, the method became the gold standard for sperm retrieval, allowing superior SSR with minimal tissue removal, but the amount of testicular dissection to find more probable spermatogenesis areas, difficulties in comparative design studies, diversity TM results among doctors and other methods that can achieve very similar results we question TM superiority. The objective is review existing literature and discuss advantages and disadvantages of all the methods for sperm retrieval in non-obstructive azoospermia. Frontiers Media S.A. 2022-08-23 /pmc/articles/PMC9580663/ /pubmed/36303631 http://dx.doi.org/10.3389/frph.2022.980824 Text en Copyright © 2022 Vieira, Bispo de Andrade and Santana-Santos. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Reproductive Health
Vieira, Marcelo
Bispo de Andrade, Marcos Alécio
Santana-Santos, Eduesley
Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title_full Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title_fullStr Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title_full_unstemmed Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title_short Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
title_sort is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men?
topic Reproductive Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580663/
https://www.ncbi.nlm.nih.gov/pubmed/36303631
http://dx.doi.org/10.3389/frph.2022.980824
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