When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,whi...When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,which need to be addressed to help clinicians and patients make informed decisions.This review explores redo micro-TESE in the context of nonobstructive azoospermia(NOA).Literature was searched using Google Scholar,Medline,and PubMed.Search terms were“NOA”AND“second microdissection testicular sperm extractions”AND“redo microdissection testicles sperm extraction”AND“repeat microdissection testicular sperm extractions”AND“failed microdissection testicular sperm extractions”AND“salvage microdissection testicular sperm extractions”.Only original articles in English were included.A total of nine articles were included,consisting of four retrospective and five prospective studies.The time gap between the first and second micro-TESE varied from 6 months to 24 months.Most of the included studies reported successful surgical sperm retrieval(SSR)in the second micro-TESE in the range of 10%–21%,except in one study where it reached 42%.It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE.Patients with hypospermatogenesis and Klinefelter syndrome(KS)had the highest chance of success in redo surgery.In conclusion,redo micro-TESE following a negative procedure can lead to sperm recovery in 10%–21%.Patients with hypospermatogenesis and KS have a higher chance of success.There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.展开更多
Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the onl...Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.展开更多
For men with severe oligozoospermia, sperm cryopreservation can preserve surgically obtained sperm. How to cryopreserve single sperm in men is still a hot topic in assisted reproduction technology. Aim to analyze the ...For men with severe oligozoospermia, sperm cryopreservation can preserve surgically obtained sperm. How to cryopreserve single sperm in men is still a hot topic in assisted reproduction technology. Aim to analyze the laboratory and pregnancy outcomes of single sperm cryopreservation group, we retrospectively selected 38 cycles underwent single sperm cryopreservation and thawing as the study group and 618 cycles underwent conventional sperm cryopreservation and thawing as the control group, which were performed in the reproductive medicine center of the Sixth Affiliated Hospital, Sun Yatsen University, from April 2014 to October 2023. All the sperm came from microdissection testicular sperm extraction (micro-TESE), and performed intracytoplasmic sperm injection (ICSI) for fertilization. Zygotes were cultured to Day 3 embryo, which were freshly transferred to female uterus. Surplus embryos were cultured to blastosphere and cryopreserved. There was no statistical difference in female/male age, female BMI, infertility duration and female basal sex hormone (FSH, LH E2, AMH), No. of oocytes retrieved per cycle, No. of ICSI oocytes per cycle and No. of embryos transferred per cycle between the two groups (P > 0.05). No significant difference was found in two-pronuclear oocyte fertilization rate (59.23% VS 58.84%), Day 3 available embryo rate (61.81% VS 63.55%), Day 3 good-quality embryo rate (45.73% VS 50.27%), blastocyst formation rate (47.83% VS 49.46%), the implantation rate (47.37% VS 52.16%), clinical pregnancy rate (36.84% VS 47.18%), miscarriage rate (14.29% VS 12.68%) and live birth rate (85.71% VS 81.70%) between two groups (P > 0.05). In conclusion, single-sperm cryopreservation was the optimal method to preserve sperm after micro-TESE. It can increase the utilization of each sperm and lead to clinical pregnancy.展开更多
The development of intracytoplasmic sperm injection （ICSI） opened a new era in the field of assisted reproduction and revolutionized the assisted reproductive technology protocols for couples with male factor infert...The development of intracytoplasmic sperm injection （ICSI） opened a new era in the field of assisted reproduction and revolutionized the assisted reproductive technology protocols for couples with male factor infertility. Fertilisation and pregnancies can be achieved with spermatozoa recovered not only from the ejaculate but also from the seminiferous tubules. The most common methods for retrieving testicular sperm in non-obstructive azoospermia （NOA） are testicular sperm aspiration （TESA： needle/fine needle aspiration） and open testicular biopsy （testicular sperm extraction： TESE）. The optimal technique for sperm extraction should be minimally invasive and avoid destruction of testicular function, without compromising the chance to retrieve adequate numbers of spermatozoa to perform ICSh Microdissection TESE （micro-TESE）, performed with an operative microscope, is widely considered to be the best method for sperm retrieval in NOA, as larger and opaque tubules, presumably with active spermatogenesis, can be directly identified, resulting in higher spermatozoa retrieval rates with minimal tissue loss and low postoperative complications. Micro-TESE, in combination with ICSI, is applicable in all cases of NOA, including Klinefelter syndrome （KS）. The outcomes of surgical sperm retrieval, primarily in NOA patients with elevated serum follicle-stimulating hormone （FSH） （NOA including KS patients）, are reviewed along with the phenotypic features. The predictive factors for surgical sperm retrieval and outcomes of treatment were analysed. Finally, the short- and long-term complications in micro-TESE in both 46XY males with NOA and KS patients are considered.展开更多
Nonobstructive azoospermia(NOA)is a serious form of male infertility with therapeutic options limited to trials of endocrine manipulations and repertoire of surgical interventions,also known as surgical sperm retrieva...Nonobstructive azoospermia(NOA)is a serious form of male infertility with therapeutic options limited to trials of endocrine manipulations and repertoire of surgical interventions,also known as surgical sperm retrieval(SSR)procedures.Despite its invasive nature,SSR remains crucial in the management of NOA,offering infertile males the opportunity of fathering their biological children using assisted reproductive technologies.Success rates of SSR are variably governed by several factors including the genetic background,preoperative endocrine optimization,testicular histopathology,surgeon's microsurgical expertise,and laboratory technological and technical team's capability.This paper explores the significant role of artificial intelligence(AI)in the process of sperm retrieval among NOA patients.The role of AI has evolved from basic predictive models used for outcome assessment and patient counseling,to advanced image processing capabilities for assessing sperm parameters,and now to cutting-edge applications in identifying the rare sperm present in the azoospermic microdissection testicular sperm extraction tissue samples.展开更多
文摘When microdissection testicular sperm extraction(micro-TESE)fails,a redo procedure may be the only option for patients who want a biological child.However,there are many gaps of knowledge surrounding the procedure,which need to be addressed to help clinicians and patients make informed decisions.This review explores redo micro-TESE in the context of nonobstructive azoospermia(NOA).Literature was searched using Google Scholar,Medline,and PubMed.Search terms were“NOA”AND“second microdissection testicular sperm extractions”AND“redo microdissection testicles sperm extraction”AND“repeat microdissection testicular sperm extractions”AND“failed microdissection testicular sperm extractions”AND“salvage microdissection testicular sperm extractions”.Only original articles in English were included.A total of nine articles were included,consisting of four retrospective and five prospective studies.The time gap between the first and second micro-TESE varied from 6 months to 24 months.Most of the included studies reported successful surgical sperm retrieval(SSR)in the second micro-TESE in the range of 10%–21%,except in one study where it reached 42%.It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE.Patients with hypospermatogenesis and Klinefelter syndrome(KS)had the highest chance of success in redo surgery.In conclusion,redo micro-TESE following a negative procedure can lead to sperm recovery in 10%–21%.Patients with hypospermatogenesis and KS have a higher chance of success.There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.
文摘Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.
文摘For men with severe oligozoospermia, sperm cryopreservation can preserve surgically obtained sperm. How to cryopreserve single sperm in men is still a hot topic in assisted reproduction technology. Aim to analyze the laboratory and pregnancy outcomes of single sperm cryopreservation group, we retrospectively selected 38 cycles underwent single sperm cryopreservation and thawing as the study group and 618 cycles underwent conventional sperm cryopreservation and thawing as the control group, which were performed in the reproductive medicine center of the Sixth Affiliated Hospital, Sun Yatsen University, from April 2014 to October 2023. All the sperm came from microdissection testicular sperm extraction (micro-TESE), and performed intracytoplasmic sperm injection (ICSI) for fertilization. Zygotes were cultured to Day 3 embryo, which were freshly transferred to female uterus. Surplus embryos were cultured to blastosphere and cryopreserved. There was no statistical difference in female/male age, female BMI, infertility duration and female basal sex hormone (FSH, LH E2, AMH), No. of oocytes retrieved per cycle, No. of ICSI oocytes per cycle and No. of embryos transferred per cycle between the two groups (P > 0.05). No significant difference was found in two-pronuclear oocyte fertilization rate (59.23% VS 58.84%), Day 3 available embryo rate (61.81% VS 63.55%), Day 3 good-quality embryo rate (45.73% VS 50.27%), blastocyst formation rate (47.83% VS 49.46%), the implantation rate (47.37% VS 52.16%), clinical pregnancy rate (36.84% VS 47.18%), miscarriage rate (14.29% VS 12.68%) and live birth rate (85.71% VS 81.70%) between two groups (P > 0.05). In conclusion, single-sperm cryopreservation was the optimal method to preserve sperm after micro-TESE. It can increase the utilization of each sperm and lead to clinical pregnancy.
文摘The development of intracytoplasmic sperm injection （ICSI） opened a new era in the field of assisted reproduction and revolutionized the assisted reproductive technology protocols for couples with male factor infertility. Fertilisation and pregnancies can be achieved with spermatozoa recovered not only from the ejaculate but also from the seminiferous tubules. The most common methods for retrieving testicular sperm in non-obstructive azoospermia （NOA） are testicular sperm aspiration （TESA： needle/fine needle aspiration） and open testicular biopsy （testicular sperm extraction： TESE）. The optimal technique for sperm extraction should be minimally invasive and avoid destruction of testicular function, without compromising the chance to retrieve adequate numbers of spermatozoa to perform ICSh Microdissection TESE （micro-TESE）, performed with an operative microscope, is widely considered to be the best method for sperm retrieval in NOA, as larger and opaque tubules, presumably with active spermatogenesis, can be directly identified, resulting in higher spermatozoa retrieval rates with minimal tissue loss and low postoperative complications. Micro-TESE, in combination with ICSI, is applicable in all cases of NOA, including Klinefelter syndrome （KS）. The outcomes of surgical sperm retrieval, primarily in NOA patients with elevated serum follicle-stimulating hormone （FSH） （NOA including KS patients）, are reviewed along with the phenotypic features. The predictive factors for surgical sperm retrieval and outcomes of treatment were analysed. Finally, the short- and long-term complications in micro-TESE in both 46XY males with NOA and KS patients are considered.
文摘Nonobstructive azoospermia(NOA)is a serious form of male infertility with therapeutic options limited to trials of endocrine manipulations and repertoire of surgical interventions,also known as surgical sperm retrieval(SSR)procedures.Despite its invasive nature,SSR remains crucial in the management of NOA,offering infertile males the opportunity of fathering their biological children using assisted reproductive technologies.Success rates of SSR are variably governed by several factors including the genetic background,preoperative endocrine optimization,testicular histopathology,surgeon's microsurgical expertise,and laboratory technological and technical team's capability.This paper explores the significant role of artificial intelligence(AI)in the process of sperm retrieval among NOA patients.The role of AI has evolved from basic predictive models used for outcome assessment and patient counseling,to advanced image processing capabilities for assessing sperm parameters,and now to cutting-edge applications in identifying the rare sperm present in the azoospermic microdissection testicular sperm extraction tissue samples.
