Yardımcı Üreme Teknolojisi için Cerrahi Sperm Elde Etme Teknikleri

İntrasitoplazmik sperm enjeksiyonu, birçok infertilite koşulu için in vitro fertilizasyon sağlamaktadır. Azospermik erkeklerde de fertilizasyon için önemli bir tedavi seçeneğidir. Azospermik erkek testislerinde sperm üretimi mümkündür. Bu hastalarda intrasitoplazmik sperm enjeksiyonundan önce epididim veya testisten sperm alınması gerekir. Epididim veya testislerden sperm elde etmek için çok sayıda sperm alma prosedürü geliştirilmiştir. Bu yöntemlerle elde edilen spermler, in vitro fertilizasyon için intrasitoplazmik sperm enjeksiyonunda kullanılmaktadır. Sperm alma yöntemini belirlerken en önemli faktör azosperminin obstrüktif veya non-obstrüktif olup olmadığıdır. Ayrıca işlemi yapan cerrahın tecrübesi de sperm alma tekniğinin belirlenmesinde etkilidir. Bu derlemede sperm elde etme yöntemleri anlatılmış ve ayrıca bu sperm elde etme yöntemleri ile ilgili güncel gelişmeler de ele alınmıştır. Hem obstrüktif hem de non-obstrüktif azospermik hastalarda cerrahi sperm elde etme yöntemlerinin endikasyonları, her bir yöntemin teknik yönleri, olası komplikasyonları, bu yöntemlerin avantaj ve dezavantajları anlatılmış ve birbirlerine göre üstünlükleri de tartışılmıştır. Ayrıca, bu yöntemlerle elde edilmiş olan sperm kullanılan intrasitoplazmik sperm enjeksiyonu sonrası fertilizasyon oranları ve gebeliğin devamına ilişkin kanıtlar karşılaştırmalı bir şekilde sunulmuş ve eleştirel bir şekilde tartışılmıştır.

Anahtar Kelimeler:

Sperm toplama, yardımcı üreme teknikleri, erkek infertilitesi, azospermi

Surgical Sperm Retrieval Techniques for Assisted Reproductive Technology

Intracytoplasmic sperm injection provides in vitro fertilization for many infertility conditions. It is also an important treatment option for fertilization in azoospermic men. Sperm production in azoospermic male testicles is possible. In these patients, sperm extraction from the epididymis or testis is required before intracytoplasmic sperm injection. Numerous sperm retrieval procedures for obtaining sperm from the epididymis or testicles have been developed. The spermatozoa obtained by these methods are used in intracytoplasmic sperm injection for in vitro fertilization. The most important factor when determining the sperm retrieval method is whether the azoospermia is obstructive or non-obstructive. In addition, the experience of the surgeon performing the procedure is also effective in determining the sperm retrieval technique. In this review, sperm retrieval methods are presented, and current developments in these sperm retrieval methods are also mentioned. The indications of surgical sperm retrieval methods in both obstructive and non-obstructive azoospermic patients, the technical aspects of each method, possible complications, advantages and disadvantages of these methods are presented, and their superiority to each other are also discussed. In addition, evidence for the fertilization rates after intracytoplasmic sperm injection using sperm obtained by these methods and continuation of pregnancy is presented in a comparative manner and critically discussed.

Keywords:

Sperm retrieval, assisted reproductive techniques, male infertility, azoospermia,

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Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;340(8810):17-8.
Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC. Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod. 1994;9(9):1705-9.
Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod. 1995;10(6):1457-60.
Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo). 2011;66(4):691-700.
Schlegel P. Causes of azoospermia and their management. Reprod Fertil Dev. 2004;16(5):561-72.
Esteves SC, Agarwal A. Sperm retrieval techniques. In: Gardner DK, Rizk BRMB, Falcone T, editors. Human assisted reproductive technology: future trends in laboratory and clinical practice. United Kingdom: Cambridge University Press; 2011. p.41-53.
Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al. European Association of Urology guidelines on male infertility: the 2012 update. Eur Urol. 2012;62(2):324-32.
Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997;158(2):467-70.
Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update. 2007;13(6):539-49.
Verza S Jr, Esteves SC. Microsurgical versus conventional single-biopsy testicular sperm extraction in nonobstructive azoospermia: a prospective controlled study. Fertil Steril. 2011;96(3):S53.
Akerman JP, Hayon S, Coward RM. Sperm extraction in obstructive azoospermia: what’s next? Urol Clin North Am. 2020;47(2):147-55.
Coward RM, Mills JN. A step-by-step guide to office-based sperm retrieval for obstructive azoospermia. Trans Androl Urol. 2017;6(4):730-44.
Yafi FA, Zini A. Percutaneous epididymal sperm aspiration for men with obstructive azoospermia: predictors of successful sperm retrieval. Urology. 2013;82(2):341-4.
Collins GN, Critchlow JD, Lau MW, Payne SR. Open versus closed epididymal sperm retrieval in men with secondarily obstructed vasal systems--a preliminary report. Br J Urol. 1996;78(3):437-9.
Pasqualotto FF, Rossi-Ferragut LM, Rocha CC, Iaconelli A Jr, Ortiz V, Borges E Jr. The efficacy of repeat percutaneous epididymal sperm aspiration procedures. J Urol. 2003;169(5):1779-81.
Esteves SC, Miyaoka R, Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol. 2011;37(5):570-83.
Qiu Y, Wang SM, Yang DT, Wang LG. Percutaneous vasal sperm aspiration and intrauterine insemination for infertile males with anejaculation. Fertil Steril. 2003;79(3):618-20.
Bachtell NE, Conaghan J, Turek PJ. The relative viability of human spermatozoa from the vas deferens, epididymis and testis before and after cryopreservation. Hum Reprod. 1999;14(12):3048-51.
Temple-Smith PD, Southwick GJ, Yates CA, Trounson AO, de Kretser DM. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert Embryo Transf. 1985;2(3):119-22.
Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14(1):131-5.
Schiff JD, Palermo GD, Veeck LL, Goldstein M, Rosenwaks Z, Schlegel PN. Success of testicular sperm extraction and intracytoplasmic sperm injection in men with Klinefelter syndrome. J Clin Endocrinol Metab. 2005;90(11):6263-7.
Ramasamy R, Yagan N, Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology. 2005;65(6):1190-4.
Carpi A, Menchini Fabris FG, Palego P, Di Coscio G, Romani R, Nardini V, et al. Fine-needle and large-needle percutaneous aspiration biopsy of testicles in men with nonobstructive azoospermia: safety and diagnostic performance. Fertil Steril. 2005;83(4):1029-33.
Turunc T, Gul U, Haydardedeoglu B, Bal N, Kuzgunbay B, Peskircioglu L, et al. Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study. Fertil Steril. 2010;94(6):2157-60.
Carpi A, Sabanegh E, Mechanick J. Controversies in the management of nonobstructive azoospermia. Fertil Steril. 2009;91(4):963-70.
Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to ICSI for azoospermia. Cochrane Database Sys Rev. 2006(3):CD002807.
Nicopoullos JD, Gilling-Smith C, Almeida PA, Norman-Taylor J, Grace I, Ramsay JW. Use of surgical sperm retrieval in azoospermic men: a meta-analysis. Fertil Steril. 2004;82(3):691-701.
Morris DS, Dunn RL, Schuster TG, Ohl DA, Smith GD. Ideal culture time for improvement in sperm motility from testicular sperm aspirates of men with azoospermia. J Urol. 2007;178(5):2087-91.