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Sperm retrieval techniques

Key Points

  • All men with obstructive azooospermia and many men with nonobstructive azoospermia will have sperm for biological pregnancies

  • Evidence is currently insufficient to recommend any specific sperm retrieval technique over another for either obstructive or nonobstructive azoospermia

  • The onus is on clinicians to develop efficient sperm retrieval techniques that maximize yield and minimize procedure numbers and morbidity

  • Obstructive azoospermia cases are associated with higher normal fertilization rates and clinical pregnancy rates compared with nonobstructive azoospermia cases

  • When fresh and frozen–thawed testicular sperm are compared, fertilization, clinical pregnancy, and ongoing clinical pregnancy rates are not different, but there is a significant decrease in implantation rates with frozen–thawed sperm

Abstract

Since the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures have been routinely employed to treat male infertility owing to azoospermia. With obstructive azoospermia, sperm is potentially harvestable from the vas deferens, epididymis, and testicle using percutaneous and open sperm retrieval procedures that are relatively straightforward and reliable. In nonobstructive azoospermia, sperm is generally found only in the testicles and can often be difficult to retrieve. Several approaches aimed at maximizing sperm yield in this condition have been developed, but only 50% of men with nonobstructive azoospermia will have clinically usable sperm. Multibiopsy testicular sperm extraction (TESE), microdissection TESE, and fine-needle-aspiration map-guided TESE are three common methods currently employed to locate and retrieve sperm in these difficult cases. Other factors that influence the use of surgically retrieved sperm for assisted reproduction include differences in sperm DNA integrity, the expertise of the surgeon and the andrology laboratory, and the described differences in the viability of sperm from different anatomical sources after freezing and thawing.

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Figure 1: Sites of sperm retrieval.
Figure 2: The vasotomy approach to sperm aspiration.
Figure 3: Microscopic epididymal sperm aspiration (MESA) technique.
Figure 4: 'Window' technique for open testicular sperm extraction (TESE).
Figure 5: Microdissection testicular sperm extraction (TESE).
Figure 6: Fine needle aspiration (FNA) mapping technique.

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Both authors researched the data for the article, provided a substantial contribution to discussions of the content and contributed to writing the article and to review and/or editing of the manuscript before submission.

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Correspondence to Paul J. Turek.

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Shin, D., Turek, P. Sperm retrieval techniques. Nat Rev Urol 10, 723–730 (2013). https://doi.org/10.1038/nrurol.2013.262

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