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Chapter 4 - History of Surgical Sperm Retrieval Techniques

from Part II - Sperm Retrieval

Published online by Cambridge University Press:  09 April 2021

By
Rupin Shah
Edited by
Ashok Agarwal ,
Ahmad Majzoub  and
Sandro C. Esteves
Ashok Agarwal
Affiliation:
The Cleveland Clinic Foundation, Cleveland, OH, USA
Ahmad Majzoub
Affiliation:
Hamad Medical Corporation, Doha, Qatar
Sandro C. Esteves
Affiliation:
Andrology & Human Reproduction Clinic, Sao Paulo, Brazil
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Summary

Early attempts at surgical sperm retrieval focused on creating artificial spermatoceles in men with vas aplasia or uncorrectable obstructive azoospermia. The collected sperm was used for intrauterine insemination, and success was rare. The major impetus to sperm retrieval came soon after the development of intracytoplasmic sperm injection, which enabled high fertilization rates and live-birth rates using sperm from the testis or epididymis. Initial cases involved men with obstructive azoospermia and sperm were retrieved microsurgically from the epididymis. Subsequently, testicular sperm, obtained by conventional biopsy, were used when sperm could not be aspirated from the epididymis. Retrieval was simplified with the development of percutaneous techniques for extracting epididymal or testicular sperm. Techniques became more complex and varied when it was realized that men with nonobstructive azoospermia may also have sperm in their testes, but these sperm-containing tubules could be very localized. Hence, a variety of percutaneous and open methods were developed that could sample the testes extensively. Initially the sampling was blind, through multidirectional aspiration or multiple random biopsies. However, these blind techniques could still miss localized areas of sperm production. Also, multiple biopsies were shown to cause testicular damage. Hence, microdissection testicular sperm extraction (mTESE) was developed, which involved visual inspection of the entire testicular parenchyma under high magnification. mTESE gives the highest sperm retrieval rates, especially when the testes are small or atrophic.

Keywords

surgical sperm retrievalintracytoplasmic sperm injectionmicrosurgurymicrodissection testicular sperm extraction
Type
Chapter
Information
Manual of Sperm Retrieval and Preparation in Human Assisted Reproduction , pp. 20 - 24
Publisher: Cambridge University Press
Print publication year: 2021

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