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Craig Niederberger MD FACSClarence C. Saelhof Professor and Head, Department of Urology, UIC College of MedicineProfessor, Department of Bioengineering, UIC College of Engineering
Sperm retrieval – preparation, technique, fresh or frozen, and when should attempting retrieval be deemed futile?
July 19, 2016
29th Annual IN VITRO FERTILIZATION AND EMBRYO TRANSFER A Comprehensive Update
Disclosures
No relationship presents a conflict of interest with the material in this presentation.
ASRM Journal Editor Medical Communications
AUA Journal Section Editor Medical Communications
Ferring Investigator Scientific Study
NexHand Co-Founder Medical Device Company
Disclosures
These drugs are off-label:
rFSHhMGClomipheneTamoxifenAnastrozoleTestolactone
Questions?
How do you know if it’s not reconstructable?
Testis or epididymis?Open, percutaneous, or microsurgical?When do you say it’s helpless?Fresh or frozen?
Retrieving sperm
Cryopreserving tissue
Medication
Azoospermia
Schoor RA, Elhanbly S, Niederberger CS, Ross LS. J Urol. 2002 Jan;167(1):197-200.
FSH and Testis Size
0%
20%
40%
60%
80%
100%96%89%
ASD: FSH > 7.6, TLA < 4.6 OA: FSH < 7.6, TLA > 4.6
You don’t need to do a biopsy for diagnosis only!
Diagnose Azoospermia
1Ubaldi F, et al. Andrologia. 1996;28 Suppl 1:71-5. 2Watkins W, et al. Fertil Steril. 1997 Mar;67(3):527-35.
Epididymal Sperm
Early on...
Van Steirteghem1
128 ICSI/MESA vs. 120 ICSI/TESE cycles
Fertilization rate 58% MESA, 60% TESE
Watkins2
72 ICSI/MESA cycles and 40 ICSI/TESE cycles
FR 67% MESA, 50% TESE, but higher implantation rates for TESE, so pregnancy rates similar: 25% TESE, 29% MESA
Required for ICSI?
If you take sperm from the epididymis, make sure the patient can’t or doesn’t want to be
reconstructed
Turek PJ, Cha I, Ljung BM.;67(3):527-35. Urology. 1997 May;49(5):743-8.
Testis Mapping
“In 27.1% of cases the fine needle aspiration map found sperm in men with sperm negative biopsies.”
Schlegel PN. Hum Reprod. 1999 Jan;14(1):131-5.
Microdissection TESE
Schlegel PN. Hum Reprod. 1999 Jan;14(1):131-5.
Microdissection TESE
TESE micro-TESE
Sperm retrieval 45% 63%
Sperm number 64K ± 52K 160K ± 270K*
Mass 720 mg 9.4 mg**
Fertilization 52% 65%*p < 0.01, **p <
0.0001
49 men, biopsy confirmed ASD22 standard TESE, 27 micro-TESE + standard TESE
TESETESE micro-TESEmicro-TESE
Sperm retrievalSperm retrieval 45%45% 63%63%
Sperm numberSperm number 64K ± 52K64K ± 52K 160K ± 270K*160K ± 270K*
MassMass 720 mg720 mg 9.4 mg**9.4 mg**
FertilizationFertilization 52%52% 65%65%
Berookhim BM, Palermo GD, Zaninovic N, Rosenwaks Z, Schlegel PN. Fertil Steril. 2014 Nov;102(5):1282-6.
FSH and Outcome
Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, Schlegel PN. Fertil Steril. 2009 Aug;92(2):590-3.
Sper
m re
triev
al ra
te
0%
20%
40%
60%
80%
100%
FSH (IU/L)<15 16-30 31-45 >45
60%67%
60%51%
Ramasamy R et al. Fertil Steril. 2011 Aug;96(2):299–302.
Ramasamy R et al. Fertil Steril. 2011 Aug;96(2):299–302.
“Of the 501 men for whom sperm were not identified by andrologists in the OR, sperm were found in the laboratory for an additional 35 (7%).”
With all the techniques available, With all the techniques available, what’s the best to do?
If it’s obstructive, you can do If it’s obstructive, you can do anything, but try to leave the anything, but try to leave the epididymis alone.If it’s spermatogenic dysfunction, go If it’s spermatogenic dysfunction, go straight to micro-TESE.Don’t biopsy to make the diagnosis!
Cryopreservation
Ohlander S, Hotaling J, Kirshenbaum E, Niederberger C, Eisenberg ML. Fertil Steril. 2014 Feb;101(2):344-9.
Failure Reanalysis
Ohlander S, Hotaling J, Kirshenbaum E, Niederberger C, Eisenberg ML. Fertil Steril. 2014 Feb;101(2):344-9.
Failure Reanalysis
Ohlander S, Hotaling J, Kirshenbaum E, Niederberger C, Eisenberg ML. Fertil Steril. 2014 Feb;101(2):344-9.
Failure Reanalysis
Moghadam KK, et al. J Androl. 2005 Sep;26(5):619–23.
Motility is Useless
Zhong C1, et al. Cell Stem Cell. 2015 Aug 6;17(2):221-32.
It’s the DNA
Zhong C1, et al. Cell Stem Cell. 2015 Aug 6;17(2):221-32.
It’s the DNA
Tanaka A, et al. Proc Natl Acad Sci U S A. 2015 Nov 24;112(47):14629-34.
It’s the DNA
Medication to improve outcomes
Hussein A, Ozgok Y, Ross L, Rao P, Niederberger C. 2013 Mar;111(3 Pt B):E110-4.
Medical TherapyPrior to TESE
Hussein A, Ozgok Y, Ross L, Rao P, Niederberger C. 2013 Mar;111(3 Pt B):E110-4.
Medical TherapyPrior to TESE
Mehta A, Bolyakov A, Roosma J, Schlegel PN, Paduch DA. Fertil Steril. 2013 Oct;100(4):970-4.
Klinefelter Syndrome
Mehta A, Bolyakov A, Roosma J, Schlegel PN, Paduch DA. Fertil Steril. 2013 Oct;100(4):970-4.
Klinefelter Syndrome
Retrieving sperm
Cryopreserving tissue
Medication
Answers!How do you know if it’s not reconstructable?
Use testis size and FSHTestis or epididymis?
TestisOpen, percutaneous, or microsurgical?
If not reconstructable, microsurgicalWhen do you say it’s helpless?
NeverFresh or frozen?
FrozenStimulate with medication beforehand?
If possible, yes
Thank You