Does testicular sperm retrieval adversely impact spermatogenesis over the long-term?

Mohammad H Alkandari 1, Joseph Moryousef 2, Armand Zini 3 4

Affiliations

07 January 2022

-

doi: 10.1111/and.14401

Abstract

Testicular sperm retrieval (TSR) techniques are valuable in the context of severe idiopathic male factor infertility; however, there are few studies in the literature examining the long-term impact of TSR on testicular function. The objective was to determine whether testicular sperm aspiration (TESA) or microdissection testicular sperm extraction (micro-TESE) worsens the pre-existing spermatogenesis deficiency in men with either cryptozoospermia or severe oligozoospermia. The study population consisted of 145 men with either cryptozoospermia or severe oligozoospermia that underwent TESA or micro-TESE and had long-term post-operative semen analyses (SA). Patients with SA prior to and following TSR were included (n = 24). Amongst them, 16 men underwent TESA and 8 underwent micro-TESE. The follow-up SA was obtained at a mean of 3.0 ± 2.0 years following TSR (range: 0.3-8.3 years) amongst all participants. The post-operative semen parameters in the TESA group were similar to the pre-intervention parameters (p > 0.1). Similarly, the micro-TESE cohort did not demonstrate significant alterations in semen parameters post-intervention (p > 0.05). None of the men in the study became azoospermic following the TSR. Our study indicates TESA or micro-TESE do not appear to worsen the pre-existing spermatogenesis deficiencies in cryptozoospermic and oligozoospermic men over a long-term period. Larger studies are required to corroborate these findings.

Keywords: TESA; male infertility; micro-TESE; sperm retrieval; spermatogenesis.

Similar articles

Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro-tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia?

Alkandari MH, Moryousef J, Phillips S, Zini A.Urology. 2021 Aug;154:164-169. doi: 10.1016/j.urology.2021.04.037. Epub 2021 May 13.PMID: 33991573

Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia.

Alrabeeah K, Wachter A, Phillips S, Cohen B, Al-Hathal N, Zini A.Andrology. 2015 May;3(3):462-6. doi: 10.1111/andr.12000. Epub 2015 Mar 17.PMID: 25784486

Is a contralateral testicular exploration required at microdissection testicular sperm extraction for men with nonobstructive azoospermia, cryptozoospermia or severe oligozoospermia?

Alkandari MH, Bouhadana D, Zini A.Andrologia. 2021 Dec;53(11):e14208. doi: 10.1111/and.14208. Epub 2021 Aug 5.PMID: 34352113

Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis.

Bernie AM, Mata DA, Ramasamy R, Schlegel PN.Fertil Steril. 2015 Nov;104(5):1099-103.e1-3. doi: 10.1016/j.fertnstert.2015.07.1136. Epub 2015 Aug 8.PMID: 26263080 Review.

[Microdissection testicular sperm extraction (MD-TESE) - a new sperm recovery technique helping men with non-obstructive azoospermia].

Westlander G, Schmidt J, Westin C.Lakartidningen. 2019 Jul 19;116:FL9I.PMID: 31334817 Review. Swedish.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Aboukhshaba, A., Punjani, N., Doukakis, S., Zaninovic, N., Palermo, G., & Schlegel, P. N. (2021). Testicular sperm characteristics in men with nonobstructive azoospermia and their impact on intracytoplasmic sperm injection outcome. Fertility and Sterility, 117(3), 522-527. https://doi.org/10.1016/j.fertnstert.2021.09.024
  2.  
    1. Achermann, A. P. P., Pereira, T. A., & Esteves, S. C. (2021). Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. International Urology and Nephrology, https://doi.org/10.1007/s11255-021-02979-4
  3.  
    1. Agarwal, A., Mulgund, A., Hamada, A., & Chyatte, M. R. (2015). A unique view on male infertility around the globe. Reproductive Biology and Endocrinology, 13(1), 37. https://doi.org/10.1186/s12958-015-0032-1
  4.  
    1. Alharbi, M., Almarzouq, A., & Zini, A. (2021). Sperm retrieval and intracytoplasmic sperm injection outcomes with testicular sperm aspiration in men with severe oligozoospermia and cryptozoospermia. Canadian Urological Association Journal, 15(5), E272-e275. https://doi.org/10.5489/cuaj.6798
  5.  
    1. Alkandari, M. H., Moryousef, J., Phillips, S., & Zini, A. (2021). Testicular sperm aspiration (TESA) or microdissection testicular sperm extraction (Micro-tese): Which approach is better in men with Cryptozoospermia and severe Oligozoospermia? Urology, 154, 164-169. https://doi.org/10.1016/j.urology.2021.04.037
  6.  
    1. Al-Malki, A. H., Alrabeeah, K., Mondou, E., Brochu-Lafontaine, V., Phillips, S., & Zini, A. (2017). Testicular sperm aspiration (TESA) for infertile couples with severe or complete asthenozoospermia. Andrology, 5(2), 226-231. https://doi.org/10.1111/andr.12317
  7.  
    1. Alrabeeah, K., Wachter, A., Phillips, S., Cohen, B., Al-Hathal, N., & Zini, A. (2015). Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia. Andrology, 3(3), 462-466. https://doi.org/10.1111/andr.12000
  8.  
    1. Alrabeeah, K., Yafi, F., Flageole, C., Phillips, S., Wachter, A., Bissonnette, F., Kadoch, I. J., & Zini, A. (2014). Testicular sperm aspiration for nonazoospermic men: sperm retrieval and intracytoplasmic sperm injection outcomes. Urology, 84(6), 1342-1346. https://doi.org/10.1016/j.urology.2014.08.032
  9.  
    1. Amer, M., Ateyah, A., Hany, R., & Zohdy, W. (2000). Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Human Reproduction, 15(3), 653-656. https://doi.org/10.1093/humrep/15.3.653
  10.  
    1. Amer, M., Haggar, S. E., Moustafa, T., El-Naser, T. A., & Zohdy, W. (1999). Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Human Reproduction, 14(12), 3030-3034. https://doi.org/10.1093/humrep/14.12.3030
  11.  
    1. Babakhanzadeh, E., Nazari, M., Ghasemifar, S., & Khodadadian, A. (2020). Some of the factors involved in male infertility: A prospective review. International Journal of General Medicine, 13, 29-41. https://doi.org/10.2147/IJGM.S241099
  12.  
    1. Barroso, L. V. S., Reges, R., Cerqueira, J. B. G., Miranda, E. P., Alcantara, R. J. A. D., Jamacaru, F. V. F., Moraes, M. O. D., Medeiros, M. A. D. S., & Gonzaga-Silva, L. F. (2018). Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model. International Brazilian Journal of Urology, 44(1), 172-179. https://doi.org/10.1590/s1677-5538.Ibju.2016.0652
  13.  
    1. Bernie, A. M., Mata, D. A., Ramasamy, R., & Schlegel, P. N. (2015). 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, 104(5), 1099-1103.e1091-1093. https://doi.org/10.1016/j.fertnstert.2015.07.1136
  14.  
    1. Chan, P. T., & Schlegel, P. N. (2000). Nonobstructive azoospermia. Current Opinion in Urology, 10(6), 617-624. https://doi.org/10.1097/00042307-200011000-00015
  15.  
    1. Cooper, T. G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H. W. G., Behre, H. M., Haugen, T. B., Kruger, T., Wang, C., Mbizvo, M. T., & Vogelsong, K. M. (2010). World Health Organization reference values for human semen characteristics. Human Reproduction Update, 16(3), 231-245. https://doi.org/10.1093/humupd/dmp048
  16.  
    1. Eliveld, J., van Wely, M., Meißner, A., Repping, S., van der Veen, F., & van Pelt, A. M. M. (2018). The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Human Reproduction Update, 24(4), 442-454. https://doi.org/10.1093/humupd/dmy015
  17.  
    1. Esteves, S. C. (2013). Microdissection testicular sperm extraction (micro-TESE) as a sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects. International Brazilian Journal of Urology, 39(3), 440-441. discussion 441. https://doi.org/10.1590/s1677-5538.Ibju.2013.03.21
  18.  
    1. Fedder, J., Marcussen, N., Fedder, M. D. K., & Engvad, B. (2017). Testicular damage following testicular sperm retrieval: A ram model study. BioMed Research International, 2017, 2472805. https://doi.org/10.1155/2017/2472805
  19.  
    1. Gorgy, A., Meniru, G. I., Naumann, N., Beski, S., Bates, S., & Craft, I. L. (1998). The efficacy of local anaesthesia for percutaneous epididymal sperm aspiration and testicular sperm aspiration. Human Reproduction, 13(3), 646-650. https://doi.org/10.1093/humrep/13.3.646
  20.  
    1. Greco, E., Scarselli, F., Iacobelli, M., Rienzi, L., Ubaldi, F., Ferrero, S., Franco, G., Anniballo, N., Mendoza, C., & Tesarik, J. (2005). Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa. Human Reproduction, 20(1), 226-230. https://doi.org/10.1093/humrep/deh590
  21.  
    1. Inhorn, M. C., & Patrizio, P. (2015). Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Human Reproduction Update, 21(4), 411-426. https://doi.org/10.1093/humupd/dmv016
  22.  
    1. Komori, K., Tsujimura, A., Miura, H., Shin, M., Takada, T., Honda, M., Matsumiya, K., & Fujioka, H. (2004). Serial follow-up study of serum testosterone and antisperm antibodies in patients with non-obstructive azoospermia after conventional or microdissection testicular sperm extraction. International Journal of Andrology, 27(1), 32-36. https://doi.org/10.1046/j.0105-6263.2003.00443.x
  23.  
    1. Mehta, A., Bolyakov, A., Schlegel, P. N., & Paduch, D. A. (2015). Higher pregnancy rates using testicular sperm in men with severe oligospermia. Fertility and Sterility, 104(6), 1382-1387. https://doi.org/10.1016/j.fertnstert.2015.08.008
  24.  
    1. Minhas, S., Bettocchi, C., Boeri, L., Capogrosso, P., Carvalho, J., Cilesiz, N. C., Cocci, A., Corona, G., Dimitropoulos, K., Gül, M., Hatzichristodoulou, G., Jones, T. H., Kadioglu, A., Martínez Salamanca, J. I., Milenkovic, U., Modgil, V., Russo, G. I., Serefoglu, E. C., Tharakan, T., … Salonia, A. (2021). European association of urology guidelines on male sexual and reproductive health: 2021 Update on male infertility. European Urology, 80(5), 603-620. https://doi.org/10.1016/j.eururo.2021.08.014
  25.  
    1. Palermo, G., Joris, H., Devroey, P., & Van Steirteghem, A. C. (1992). Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet, 340(8810), 17-18. https://doi.org/10.1016/0140-6736(92)92425-f
  26.  
    1. Ramasamy, R., Yagan, N., & Schlegel, P. N. (2005). Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology, 65(6), 1190-1194. https://doi.org/10.1016/j.urology.2004.12.059
  27.  
    1. Schlegel, P. N. (1999). Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Human Reproduction, 14(1), 131-135. https://doi.org/10.1093/humrep/14.1.131
  28.  
    1. Schlegel, P. N., Sigman, M., Collura, B., De Jonge, C. J., Eisenberg, M. L., Lamb, D. J., Mulhall, J. P., Niederberger, C., Sandlow, J. I., Sokol, R. Z., Spandorfer, S. D., Tanrikut, C., Treadwell, J. R., Oristaglio, J. T., & Zini, A. (2021). Diagnosis and treatment of infertility in men: AUA/ASRM guideline PART II. Journal of Urology, 205(1), 44-51. https://doi.org/10.1097/ju.0000000000001520
  29.  
    1. Schlegel, P. N., & Su, L. M. (1997). Physiological consequences of testicular sperm extraction. Human Reproduction, 12(8), 1688-1692. https://doi.org/10.1093/humrep/12.8.1688
  30.  
    1. Turunc, T., Gul, U., Haydardedeoglu, B., Bal, N., Kuzgunbay, B., Peskircioglu, L., & Ozkardes, H. (2010). Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study. Fertility and Sterility, 94(6), 2157-2160. https://doi.org/10.1016/j.fertnstert.2010.01.008

Page Navigation