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Testicular sperm extraction

January 01, 1970

Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF).[1] TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia.[2]

Testicular sperm extraction
Tissue is extracted from the seminiferous tubules during surgery in TESE
SpecialtyReproductive medicine
[edit on Wikidata]

Medical uses edit

TESE is recommended to patients who do not have sperm present in their ejaculate, azoospermia, or who cannot ejaculate at all. In general, azoospermia can be divided into obstructive and non-obstructive subcategories.[citation needed]

TESE is primarily used for non-obstructive azoospermia, where patients do not have sperm present in the ejaculate but who may produce sperm in the testis. Azoospermia in these patients could be a result of Y chromosome microdeletions, cancer of the testicles or damage to the pituitary gland or hypothalamus, which regulate sperm production. Often in these cases, TESE is used as a second option, after prior efforts to treat the azoospermia through hormone therapy have failed.[3]

However, if azoospermia is related to a disorder of sexual development, such as Klinefelter syndrome, TESE is not used clinically; as of 2016, this was in the research phase.[4]

More rarely, TESE is used to extract sperm in cases of obstructive azoospermia.[5] Obstructive azoospermia can be caused in a variety of ways:

TESE can also be used as a fertility preservation option for patients undergoing gender reassignment surgery and who cannot ejaculate sperm.[7]

Technique edit

Conventional TESE is usually performed under local, or sometimes spinal or general, anaesthesia.[8][9] An incision in the median raphe of the scrotum is made and continued through the dartos fibres and the tunica vaginalis. The testicle and epidydymis are then visible.[10] Incisions are then made through the outer covering of the testis to retrieve biopsies of seminiferous tubules, which are the structures that contain sperm. The incision is closed with sutures and each sample is assessed under a microscope to confirm the presence of sperm.[8]

Following extraction, sperm is often cryogenically preserved for future use, but can also be used fresh.[11]

Micro-TESE edit

Micro-TESE, or microdissection testicular sperm extraction, includes the use of an operating microscope. This allows the surgeon to observe regions of seminiferous tubules of the testes that have more chance of containing spermatozoa.[2] The procedure is more invasive than conventional TESE, requiring general anaesthetic, and usually used only in patients with non-obstructive azoospermia.[12] Similarly to TESE, an incision is made in the scrotum and surface of the testicle to expose seminiferous tubules. However, this exposure is much more wide in micro-TESE. This allows exploration of the incision under the microscope to identify areas of tubules more likely to contain more sperm. If none can be identified, biopsies are instead taken at random from a wide range of locations. The incision is closed with sutures. Samples are re-examined post-surgery to locate and then purify sperm.[8]

When compared with FNA of the testis, conventional TESE is 2-fold more effective at identifying sperm in men with non-obstructive azoospermia. Compared with conventional TESE, micro-TESE has about 1.5-fold higher success in extracting sperm; as such, micro-TESE is preferable in cases of non-obstructive azoospermia< , where infertility is caused by a lack of sperm production rather than a blockage.[13] In these cases, micro-TESE is more likely to yield sufficient sperm for use in ICSI.[14]

TESE vs TESA edit

TESE is different to testicular sperm aspiration (TESA). TESA is done under local anaesthesia, does not involve an open biopsy and is suitable for patients with obstructive azoospermia.[13]

Complications edit

Micro-TESE and TESE have risks of postoperative infection, bleeding and pain.[10] TESE can result in testicular abnormalities and scarring of the tissue. The procedure can cause testicular fibrosis and inflammation, which can reduce testicular function and cause testicular atrophy.[15] Both procedures can alter the steroid function of the testes causing a decline in serum testosterone levels, which can result in testosterone deficiency.[12] This can cause side-effects including muscle weakness, decreased sexual function, anxiety, leading to sleep deficiency.[16] The blood supply to the testis can also be altered during this procedure, potentially reducing supply. Long-term follow-ups are often recommended to prevent these complications.[12]

Micro-TESE has limited postoperative complications compared with TESE. The use of the surgical microscope allows for small specific incisions to retrieve seminiferous tubules and evade damaging blood vessels by avoiding regions with no vasculature.[3][10]

If TESE needs to be repeated due to insufficient sperm recovery, patients are usually advised to wait 6–12 months in order to allow adequate healing of the testis before further surgery.[17]

See also edit

References edit

  1. ^ Graham, Sam D.; Keane, Thomas E. (2015-09-04). Glenn's urologic surgery. Keane, Thomas E.,, Graham, Sam D., Jr.,, Goldstein, Marc (8th ed.). Philadelphia, PA. ISBN 9781496320773. OCLC 927100060.{{cite book}}: CS1 maint: location missing publisher (link)
  2. ^ a b c Dabaja, Ali A.; Schlegel, Peter N. (2013). "Microdissection testicular sperm extraction: an update". Asian Journal of Andrology. 15 (1): 35–39. doi:10.1038/aja.2012.141. ISSN 1745-7262. PMC 3739122. PMID 23241638.
  3. ^ a b Flannigan, Ryan; Bach, Phil V.; Schlegel, Peter N. (2017). "Microdissection testicular sperm extraction". Translational Andrology and Urology. 6 (4): 745–752. doi:10.21037/tau.2017.07.07. ISSN 2223-4691. PMC 5583061. PMID 28904907.
  4. ^ Gies, Inge; Oates, Robert; De Schepper, Jean; Tournaye, Herman (2016). "Testicular biopsy and cryopreservation for fertility preservation of prepubertal boys with Klinefelter syndrome: a pro/con debate". Fertility and Sterility. 105 (2): 249–255. doi:10.1016/j.fertnstert.2015.12.011. ISSN 1556-5653. PMID 26748226.
  5. ^ Westlander, Göran; Schmidt, Johanna; Westin, Cecilia (2019-07-19). "[Microdissection testicular sperm extraction (MD-TESE) - a new sperm recovery technique helping men with non-obstructive azoospermia]". Läkartidningen. 116: FL9I. ISSN 1652-7518. PMID 31334817.
  6. ^ "Infertility - Treatment". nhs.uk. 2017-10-23. Retrieved 2019-09-24.
  7. ^ Liu, Wen; Schulster, Michael L.; Alukal, Joseph P.; Najari, Bobby B. (2019-08-16). "Fertility Preservation in Male to Female Transgender Patients". Urologic Clinics of North America. 46 (4): 487–493. doi:10.1016/j.ucl.2019.07.003. ISSN 0094-0143. PMID 31582023. S2CID 201991902.
  8. ^ a b c Esteves, Sandro C.; Miyaoka, Ricardo; Agarwal, Ashok (2011). "Sperm retrieval techniques for assisted reproduction". International Braz J Urol. 37 (5): 570–583. doi:10.1590/s1677-55382011000500002. ISSN 1677-6119. PMID 22099268.
  9. ^ "Surgical sperm extraction | Human Fertilisation and Embryology Authority". www.hfea.gov.uk. Retrieved 2019-09-25.
  10. ^ a b c Janosek-Albright, Kirsten J. C.; Schlegel, Peter N.; Dabaja, Ali A. (2015). "Testis sperm extraction". Asian Journal of Urology. 2 (2): 79–84. doi:10.1016/j.ajur.2015.04.018. ISSN 2214-3882. PMC 5730746. PMID 29264124.
  11. ^ "What is Sperm Retrieval? - Urology Care Foundation". www.urologyhealth.org. Retrieved 2019-09-24.
  12. ^ a b c Tsujimura, Akira (2007). "Microdissection testicular sperm extraction: prediction, outcome, and complications". International Journal of Urology. 14 (10): 883–889. doi:10.1111/j.1442-2042.2007.01828.x. ISSN 0919-8172. PMID 17880285. S2CID 26300128.
  13. ^ a b Bernie, Aaron M.; Mata, Douglas A.; Ramasamy, Ranjith; Schlegel, Peter 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.e1–3. doi:10.1016/j.fertnstert.2015.07.1136. ISSN 1556-5653. PMID 26263080.
  14. ^ Klami, Rauni; Mankonen, Harri; Perheentupa, Antti (2018). "Successful microdissection testicular sperm extraction for men with non-obstructive azoospermia". Reproductive Biology. 18 (2): 137–142. doi:10.1016/j.repbio.2018.03.003. ISSN 2300-732X. PMID 29602610. S2CID 4489364.
  15. ^ Chiba, Koji; Enatsu, Noritoshi; Fujisawa, Masato (2016). "Management of non-obstructive azoospermia". Reproductive Medicine and Biology. 15 (3): 165–173. doi:10.1007/s12522-016-0234-z. ISSN 1445-5781. PMC 5715857. PMID 29259433.
  16. ^ "Surgical sperm extraction | Human Fertilisation and Embryology Authority". www.hfea.gov.uk. Retrieved 2019-09-24.
  17. ^ "Microscopic Testicular Sperm Extraction + Fertility". Cleveland Clinic. Retrieved 2019-09-24.

January 01, 1970
testicular, sperm, extraction, tese, surgical, procedure, which, small, portion, tissue, removed, from, testicle, viable, sperm, cells, from, that, tissue, extracted, further, procedures, most, commonly, intracytoplasmic, sperm, injection, icsi, part, vitro, f. Testicular sperm extraction TESE is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures most commonly intracytoplasmic sperm injection ICSI as part of in vitro fertilisation IVF 1 TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia 2 Testicular sperm extractionTissue is extracted from the seminiferous tubules during surgery in TESESpecialtyReproductive medicine edit on Wikidata Contents 1 Medical uses 2 Technique 2 1 Micro TESE 2 2 TESE vs TESA 3 Complications 4 See also 5 ReferencesMedical uses editTESE is recommended to patients who do not have sperm present in their ejaculate azoospermia or who cannot ejaculate at all In general azoospermia can be divided into obstructive and non obstructive subcategories citation needed TESE is primarily used for non obstructive azoospermia where patients do not have sperm present in the ejaculate but who may produce sperm in the testis Azoospermia in these patients could be a result of Y chromosome microdeletions cancer of the testicles or damage to the pituitary gland or hypothalamus which regulate sperm production Often in these cases TESE is used as a second option after prior efforts to treat the azoospermia through hormone therapy have failed 3 However if azoospermia is related to a disorder of sexual development such as Klinefelter syndrome TESE is not used clinically as of 2016 this was in the research phase 4 More rarely TESE is used to extract sperm in cases of obstructive azoospermia 5 Obstructive azoospermia can be caused in a variety of ways vasectomy trauma congenital absence of the vas deferens CAVD cystic fibrosis 2 6 TESE can also be used as a fertility preservation option for patients undergoing gender reassignment surgery and who cannot ejaculate sperm 7 Technique editConventional TESE is usually performed under local or sometimes spinal or general anaesthesia 8 9 An incision in the median raphe of the scrotum is made and continued through the dartos fibres and the tunica vaginalis The testicle and epidydymis are then visible 10 Incisions are then made through the outer covering of the testis to retrieve biopsies of seminiferous tubules which are the structures that contain sperm The incision is closed with sutures and each sample is assessed under a microscope to confirm the presence of sperm 8 Following extraction sperm is often cryogenically preserved for future use but can also be used fresh 11 Micro TESE edit Micro TESE or microdissection testicular sperm extraction includes the use of an operating microscope This allows the surgeon to observe regions of seminiferous tubules of the testes that have more chance of containing spermatozoa 2 The procedure is more invasive than conventional TESE requiring general anaesthetic and usually used only in patients with non obstructive azoospermia 12 Similarly to TESE an incision is made in the scrotum and surface of the testicle to expose seminiferous tubules However this exposure is much more wide in micro TESE This allows exploration of the incision under the microscope to identify areas of tubules more likely to contain more sperm If none can be identified biopsies are instead taken at random from a wide range of locations The incision is closed with sutures Samples are re examined post surgery to locate and then purify sperm 8 When compared with FNA of the testis conventional TESE is 2 fold more effective at identifying sperm in men with non obstructive azoospermia Compared with conventional TESE micro TESE has about 1 5 fold higher success in extracting sperm as such micro TESE is preferable in cases of non obstructive azoospermia lt where infertility is caused by a lack of sperm production rather than a blockage 13 In these cases micro TESE is more likely to yield sufficient sperm for use in ICSI 14 TESE vs TESA edit TESE is different to testicular sperm aspiration TESA TESA is done under local anaesthesia does not involve an open biopsy and is suitable for patients with obstructive azoospermia 13 Complications editMicro TESE and TESE have risks of postoperative infection bleeding and pain 10 TESE can result in testicular abnormalities and scarring of the tissue The procedure can cause testicular fibrosis and inflammation which can reduce testicular function and cause testicular atrophy 15 Both procedures can alter the steroid function of the testes causing a decline in serum testosterone levels which can result in testosterone deficiency 12 This can cause side effects including muscle weakness decreased sexual function anxiety leading to sleep deficiency 16 The blood supply to the testis can also be altered during this procedure potentially reducing supply Long term follow ups are often recommended to prevent these complications 12 Micro TESE has limited postoperative complications compared with TESE The use of the surgical microscope allows for small specific incisions to retrieve seminiferous tubules and evade damaging blood vessels by avoiding regions with no vasculature 3 10 If TESE needs to be repeated due to insufficient sperm recovery patients are usually advised to wait 6 12 months in order to allow adequate healing of the testis before further surgery 17 See also editAzoospermia Intracytoplasmic sperm injection Percutaneous epididymal sperm aspiration Semen cryopreservationReferences edit Graham Sam D Keane Thomas E 2015 09 04 Glenn s urologic surgery Keane Thomas E Graham Sam D Jr Goldstein Marc 8th ed Philadelphia PA ISBN 9781496320773 OCLC 927100060 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link a b c Dabaja Ali A Schlegel Peter N 2013 Microdissection testicular sperm extraction an update Asian Journal of Andrology 15 1 35 39 doi 10 1038 aja 2012 141 ISSN 1745 7262 PMC 3739122 PMID 23241638 a b Flannigan Ryan Bach Phil V Schlegel Peter N 2017 Microdissection testicular sperm extraction Translational Andrology and Urology 6 4 745 752 doi 10 21037 tau 2017 07 07 ISSN 2223 4691 PMC 5583061 PMID 28904907 Gies Inge Oates Robert De Schepper Jean Tournaye Herman 2016 Testicular biopsy and cryopreservation for fertility preservation of prepubertal boys with Klinefelter syndrome a pro con debate Fertility and Sterility 105 2 249 255 doi 10 1016 j fertnstert 2015 12 011 ISSN 1556 5653 PMID 26748226 Westlander Goran Schmidt Johanna Westin Cecilia 2019 07 19 Microdissection testicular sperm extraction MD TESE a new sperm recovery technique helping men with non obstructive azoospermia Lakartidningen 116 FL9I ISSN 1652 7518 PMID 31334817 Infertility Treatment nhs uk 2017 10 23 Retrieved 2019 09 24 Liu Wen Schulster Michael L Alukal Joseph P Najari Bobby B 2019 08 16 Fertility Preservation in Male to Female Transgender Patients Urologic Clinics of North America 46 4 487 493 doi 10 1016 j ucl 2019 07 003 ISSN 0094 0143 PMID 31582023 S2CID 201991902 a b c Esteves Sandro C Miyaoka Ricardo Agarwal Ashok 2011 Sperm retrieval techniques for assisted reproduction International Braz J Urol 37 5 570 583 doi 10 1590 s1677 55382011000500002 ISSN 1677 6119 PMID 22099268 Surgical sperm extraction Human Fertilisation and Embryology Authority www hfea gov uk Retrieved 2019 09 25 a b c Janosek Albright Kirsten J C Schlegel Peter N Dabaja Ali A 2015 Testis sperm extraction Asian Journal of Urology 2 2 79 84 doi 10 1016 j ajur 2015 04 018 ISSN 2214 3882 PMC 5730746 PMID 29264124 What is Sperm Retrieval Urology Care Foundation www urologyhealth org Retrieved 2019 09 24 a b c Tsujimura Akira 2007 Microdissection testicular sperm extraction prediction outcome and complications International Journal of Urology 14 10 883 889 doi 10 1111 j 1442 2042 2007 01828 x ISSN 0919 8172 PMID 17880285 S2CID 26300128 a b Bernie Aaron M Mata Douglas A Ramasamy Ranjith Schlegel Peter 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 e1 3 doi 10 1016 j fertnstert 2015 07 1136 ISSN 1556 5653 PMID 26263080 Klami Rauni Mankonen Harri Perheentupa Antti 2018 Successful microdissection testicular sperm extraction for men with non obstructive azoospermia Reproductive Biology 18 2 137 142 doi 10 1016 j repbio 2018 03 003 ISSN 2300 732X PMID 29602610 S2CID 4489364 Chiba Koji Enatsu Noritoshi Fujisawa Masato 2016 Management of non obstructive azoospermia Reproductive Medicine and Biology 15 3 165 173 doi 10 1007 s12522 016 0234 z ISSN 1445 5781 PMC 5715857 PMID 29259433 Surgical sperm extraction Human Fertilisation and Embryology Authority www hfea gov uk Retrieved 2019 09 24 Microscopic Testicular Sperm Extraction Fertility Cleveland Clinic Retrieved 2019 09 24 Retrieved from https en wikipedia org w index php title Testicular sperm extraction amp oldid 1183783127, wikipedia, wiki, book, books, library,

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