Sperm Extraction

Sperm Extraction



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Sperm Extraction
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Testicular sperm extraction (TESE)
Microscopic Testicular Sperm Extraction by Dr. Manu Gupta - YouTube
Testicular sperm extraction — Wikipedia Republished // WIKI 2
Sperm Extraction смотреть видео онлайн в hd качестве 1080
(PDF) Genomic DNA Extraction from Sperm
Tissue is extracted from the seminiferous tubules during surgery in TESE

^ 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 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 .

^ "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 .

^ 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 .

^ a b "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 .

^ 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 .

^ 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 .




This page was last edited on 17 April 2020, at 10:54

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Tes­tic­u­lar sperm ex­trac­tion (TESE) is the sur­gi­cal pro­ce­dure of re­mov­ing a small por­tion of tis­sue from the tes­ti­cle and ex­tract­ing any vi­able sperm cells from that tis­sue 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]

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.

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 cur­rently used clin­i­cally; this is cur­rently in the re­search phase. [4]

More rarely, TESE is used to ex­tract sperm in cases of ob­struc­tive azoosper­mia. 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. [6]

Con­ven­tional TESE is usu­ally per­formed under local, or some­times spinal or gen­eral, anaes­the­sia . [7] [8] 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. [9] From here in­ci­sion/s are through the outer cov­er­ing of the testis to re­trieve biop­sies of sem­i­nif­er­ous tubules, the struc­tures which con­tain sperm. The in­ci­sion is closed with su­tures and each sam­ple is as­sessed under a mi­cro­scope to con­firm the pres­ence of sperm. [7]

Fol­low­ing ex­trac­tion, sperm is often cryo­geni­cally pre­served for fu­ture use, but can also be used fresh. [10]

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. [11] 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. [7]

When com­pared with con­ven­tional TESE, mi­cro-TESE gen­er­ally has 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. [12] [10] In these cases, mi­cro-TESE is more likely to yield suf­fi­cient sperm for use in ICSI. [13]

TESE is dif­fer­ent to tes­tic­u­lar sperm as­pi­ra­tion (TESA). TESA is done under local anaethe­sia, does not in­volve an open biopsy and is suit­able for pa­tients with ob­struc­tive azoospermia. [12]

Like all sur­gi­cal op­er­a­tions, mi­cro-TESE and TESE have risks of post­op­er­a­tive in­fec­tion, bleed­ing and pain. [9] How­ever, TESE can re­sult in tes­tic­u­lar ab­nor­mal­i­ties and scar­ring of the tis­sue. The pro­ce­dure can also cause tes­tic­u­lar fi­bro­sis and in­flam­ma­tion, which can re­duce tes­tic­u­lar func­tion and cause tes­tic­u­lar atrophy. [14] Both pro­ce­dures can alter the steroid func­tion of the testes caus­ing a de­cline in serum testos­terone lev­els, which can re­sult in testos­terone de­fi­ciency . [11] This can cause side-ef­fects in­clud­ing mus­cle weak­ness, de­creased sex­ual func­tion, anx­i­ety, lead­ing to sleep deficiency. [15] 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. [11]

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] [9]

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. [16]


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