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Diagnostic and therapeutic testis biopsy

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Abstract

Testicular biopsy has been traditionally used as a diagnostic tool in the management of infertility. With the advent of assisted reproductive technology, testicular biopsy is now used therapeutically to retrieve sperm for intracytoplasmic sperm injection (ICSI). The feasibility of testicular sperm extraction for ICSI is reviewed in this article. Although less invasive techniques such as testicular fine needle aspiration and percutaneous needle biopsy are efficacious, particularly in cases of obstructive azoospermia, studies in the current literature support that open testicular biopsy is a more reliable method to obtain testicular specimen. Different measures to reduce the complication rate of open testicular biopsy, including the application of microsurgical techniques, are addressed here. Other areas of recent development related to testicular biopsy that are reviewed include processing of testicular tissue, cryopreservation of retrieved spermatozoa, in vitro maturation of spermatozoa, and microinjection of immature spermatogenic precursor cells.

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References and Recommended Reading

  1. Craft I, Bennett V, Nicholson N: Fertilising ability of testicular spermatozoa. Lancet 1993, 342:864.

    Article  PubMed  CAS  Google Scholar 

  2. Schoysman R, Lejeune B, Segal L, et al.: New therapeutic possibilities handling residual azoospermia. Acta Eur Fertil 1995, 26:131–136.

    PubMed  CAS  Google Scholar 

  3. Silber SJ, van Steirteghem AC, Liu J, et al.: High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy. Hum Reprod 1995, 10:148–152.

    Article  PubMed  CAS  Google Scholar 

  4. Jow WW, Steckel J, Schlegel PN, et al.: Motile sperm in human testis biopsy specimens. J Androl 1993, 14:194–198.

    PubMed  CAS  Google Scholar 

  5. Devroey P, Liu J, Nagy Z, et al.: Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 1995, 10:1457–1460.

    PubMed  CAS  Google Scholar 

  6. Silber SJ, Nagy Z, Devroey P, et al.: Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure. Hum Reprod 1997, 12:2422–2428.

    Article  PubMed  CAS  Google Scholar 

  7. Palermo GD, Schlegel PN, Sills ES, et al.: Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter’s syndrome. N Engl J Med 1998, 338:588–590.

    Article  PubMed  CAS  Google Scholar 

  8. Chan PTK, Palermo GD, Veeck LL, et al.: TESE-ICSI as a treatment for men with persistent azoospermia post-chemotherapy. J Urol 2000, 163:343a.

    Article  Google Scholar 

  9. Hourvitz A, Shulman A, Madjar I, et al.: In vitro fertilization treatment for severe male factor: a comparative study of intracytoplasmic sperm injection with testicular sperm extraction and with spermatozoa from ejaculate. J Assist Reprod Genet 1998, 15:386–389.

    Article  PubMed  CAS  Google Scholar 

  10. Palermo GD, Schlegel PN, Hariprashad JJ, et al.: Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999, 14:741–748.

    Article  PubMed  CAS  Google Scholar 

  11. Tournaye H, Verheyen G, Nagy P, et al.: Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod 1997, 12:80–86.

    Article  PubMed  CAS  Google Scholar 

  12. Su L-M, Palermo GD, Goldstein M, et al.: Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia: testicular histology can predict success of sperm retrieval. J Urol 1999, 161:112–116. This article emphasizes the fact that the most advanced pattern of spermatogenesis on a diagnostic biopsy, not the predominant pattern, determines the chance of sperm retrieval.

    Article  PubMed  CAS  Google Scholar 

  13. Schlegel PN, Su L-M: Physiological consequences of testicular sperm extraction. 1997. Hum Reprod 1997, 12:1688–1692.

    Article  PubMed  CAS  Google Scholar 

  14. Ron-El R, Strauss S, Friedler S, et al.: Serial sonography and colour flow doppler imaging following testicular and epididymal sperm extraction. Hum Reprod 1998, 13:3390–3393.

    Article  PubMed  CAS  Google Scholar 

  15. Jarow JP: Intratesticular arterial anatomy. J Androl 1990, 11:255–259.

    PubMed  CAS  Google Scholar 

  16. Harrington TG, Schauer D, Gilbert BR: Percutaneous testis biopsy: an alternative to open testicular biopsy in the evaluation of the subfertile man. J Urol 1996, 156:1647–1651.

    Article  PubMed  CAS  Google Scholar 

  17. Schlegel PN: Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999, 14:131–135. This article describes a new microsurgical technique applied in TESE which results in an improved yield of sperm retrieval over standard TESE with a minimal amount of testicular tissue removed.

    Article  PubMed  CAS  Google Scholar 

  18. Dardashiti K, Williams RH, Goldstein M: Microsurgical testis biopsy: novel technique for retrieval of testicular tissue. J Urol 2000, 163:1216–1218.

    Article  Google Scholar 

  19. Turek PJ, Givens CR, Schriock ED, et al.: Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine-needle aspiration mapping in patients with nonobstructive azoospermia. Fertil Steril 1999, 71:552–557.

    Article  PubMed  CAS  Google Scholar 

  20. Foresta C, Garolla A, Bettella A, et al.: Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod 1998, 13:3090–3093.

    Article  PubMed  CAS  Google Scholar 

  21. Belker AM, Sherins RJ, Dennison-Lagos L, et al.: Percutaneous testicular sperm aspiration: a convenient and effective office procedure to retrieve sperm for in vitro fertilization with intracytoplasmic sperm injection. J Urol 1998, 160:2058–2062.

    Article  PubMed  CAS  Google Scholar 

  22. Tournaye H, Clasen K, Aytoz A, et al.: Fine needle aspiration versus open biopsy for testicular sperm recovery: a controlled study in azoospermic patients with normal spermatogenesis. Hum Reprod 1998, 13:901–904.

    Article  PubMed  CAS  Google Scholar 

  23. Lewin A, Reubinoff B, Porat-Katz A, et al.: Testicular fine needle aspiration: the alternative method for sperm retrieval in non-obstructive azoospermia. Hum Reprod 1999, 14:1785–1790. The technique described here for testicular aspiration is associated with a high success rate in nonobstructive azoospermic men.

    Article  PubMed  CAS  Google Scholar 

  24. Friedler S, Raziel A, Strassburger D, et al.: Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997, 12:1488–1493.

    Article  PubMed  CAS  Google Scholar 

  25. Ezeh UIO, Moore HDM, Cooke ID: A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 1998a, 13:3075–3080.

    Article  PubMed  CAS  Google Scholar 

  26. Tournaye H: Surgical sperm recovery for intracytoplasmic sperm injection: which method is to be preferred? Hum Reprod 1999, 14(suppl):71–81.

    Article  PubMed  Google Scholar 

  27. Westlander G, Hamberger L, Hanson C, et al.: Diagnostic epididymal and testicular sperm recovery and genetic aspects in azoospermic men. Hum Reprod 1999, 14:118–122. This article documents the benefit of open TESE over needle aspiration.

    Article  PubMed  CAS  Google Scholar 

  28. Morey AF, MacDonald MF, Rozanski TA, et al.: Yield and efficacy of biopsy gun testis needle biopsy. Urology 1999, 53:604–607.

    Article  PubMed  CAS  Google Scholar 

  29. Sheynkin YR, Ye Z, Menendez S, et al.: Controlled comparison of percutaneous and microsurgical sperm retrieval in men with obstructive azoospermia. Hum Reprod 1998, 13:3086–3089.

    Article  PubMed  CAS  Google Scholar 

  30. Tuuri T, Moilanen J, Kaukoranta S, et al.: Testicular biopsy gun needle biopsy in collecting spermatozoa for intracytoplasmic injection, cryopreservation and histology. Hum Reprod 1998, 14:1274–1278.

    Article  Google Scholar 

  31. Ostad M, Liotta D, Ye Z, Schlegel PN: Testicular sperm extraction for nonobstructive azoospermia: results of a multibiopsy approach with optimized tissue dispersion. Urology 1998, 52:692–696. This study documents the high number of random testicular samples needed to find sperm in TESE for nonobstructive azoospermia. In addition, the importance of optimized mechanical tissue dispersion to find sperm is emphasized.

    Article  PubMed  CAS  Google Scholar 

  32. Crabbe E, Verheyen G, Silber S, et al.: Enzymatic digestion of testicular tissue may rescue the intracytoplasmic sperm injection cycle in some patients with non-obstructive azoospermia. Hum Reprod 1998, 13:2791–2796. The simple protocol used in this article has the potential to significantly increase the yield of spermatozoa in TESE. The safety of use of the enzymes for treatment of sperm that are to be applied with ICSI has not been shown.

    PubMed  CAS  Google Scholar 

  33. Cremades N, Bernabeu Rafael Barros, Sousa M: In-vitro maturation of round spermatids using co-culture on Vero cells. Hum Reprod 1999, 14:1287–1293.

    Article  PubMed  CAS  Google Scholar 

  34. Tesarik J, Greco E, Rienzi L, et al.: Differentiation of spermatogenic cells during in-vitro culture of testicular biopsy samples from patients with obstructive azoospermia: effect of recombinant follicle stimulating hormone. Hum Reprod 1998a, 13:2772–2781.

    PubMed  CAS  Google Scholar 

  35. Tesarik J, Maurizio G, Mendoza C, Greco E: Human spermatogenesis in vitro: respective effects of follicle-stimulating hormone and testosterone on meiosis, spermiogenesis, and Sertoli cell apoptosis. J Clin Endocrinol Metab 1998b, 83:4467–4473.

    Article  PubMed  CAS  Google Scholar 

  36. Tesarik J, Mendoza C, Greco E: In vitro culture facilitates the selection of healthy spermatids for assisted reproduction. Fertil Steril 1999a, 72:809–813. This article addressed the potential of in vitro spermatogenesis that may improve the yield and quality of spermatogenic cells for ICSI.

    Article  PubMed  CAS  Google Scholar 

  37. Hu Y, Maxson WS, Hoffman DI, et al.: Clinical application of intracytoplasmic sperm injection using in vitro cultured testicular spermatozoa obtained the day before egg retrieval. Fertil Steril 1999, 72:666–669.

    Article  PubMed  CAS  Google Scholar 

  38. Mulhall JP, Burgess CM, Cunningham D, et al.: Presence of mature sperm in testicular parenchyma of men with nonobstructive azoospermia: prevalence and predictive factors. Urology 1997, 49:91–96.

    Article  PubMed  CAS  Google Scholar 

  39. Ezeh UIO, Martin M, Cooke ID, Moore HDM: Correlation of testicular pathology and sperm extraction in azoospermic men with ejaculated spermatids detected by immunofluorescent localization. Hum Reprod 1998b, 13:3061–3065.

    Article  PubMed  CAS  Google Scholar 

  40. Ezeh UIO, Moore HDM, Cooke ID: Correlation of testicular sperm extraction with morphological, biophysical and endocrine profiles in men with azoospermia due to primary gonadal failure. Hum Reprod 1998c, 13:3066–3074.

    Article  PubMed  CAS  Google Scholar 

  41. Gil-Salom M, Romero J, Minguez Y, et al.: Testicular sperm extraction and intracytoplasmic sperm injection: a chance of fertility in non-obstructive azoospermia. J Urol 1998, 160:2063–2067.

    Article  PubMed  CAS  Google Scholar 

  42. Hammadeh ME, Al-Hasani S, Doerr S, et al.: Comparison between chromatin condensation and morphology from testis biopsy extracted and ejaculated spermatozoa and their relationship to ICSI outcome. Hum Reprod 1999, 14:363–367.

    Article  PubMed  CAS  Google Scholar 

  43. Schulze W, Thomas F, Knuth UA: Testicular sperm extraction: comprehensive analysis with simultaneously performed histology in 1418 biopsies from 766 subfertile men. Hum Reprod 1999, 14(suppl 1):82–96.

    PubMed  Google Scholar 

  44. von Eckardstein S, Simoni M, Bergmann M, et al.: Serum inhibin B in combination with serum follicle-stimulating hormone (FSH) is a more sensitive marker than serum FSH alone for impaired spermatogenesis in men, but cannot predict the presence of sperm in testicular tissue samples. J Clin Endocrinol Metab 1999, 84:2496–2501.

    Article  Google Scholar 

  45. Ben-Yosef D, Yogev L, Hauser R, et al.: Testicular sperm retrieval and cryopreservation prior to initiating ovarian stimulation as the first line approach in patients with nonobstructive azoospermia. Hum Reprod 1999, 14:1794–1801. Strong evidence is provided that cryopreserved spermatozoa from nonobstructive azoospermic men can be successfully used for ICSI. Because the pregnancy rates are lower in these series than others where fresh testicular sperm is used for ICSI, it is unclear which approach is preferable.

    Article  PubMed  CAS  Google Scholar 

  46. Prins GS, Dolgina R, Studney P, et al.: Quality of cryopreserved testicular sperm in patients with obstructive and nonobstructive azoospermia. J Urol 1999, 161:1504–1508. Like the previous reference, strong evidence is provided that cryopreserved spermatozoa from nonobstructive azoospermic men can be successfully used for ICSI. Because the pregnancy rates are lower in these series than others where fresh testicular sperm is used for ICSI, is unclear which approach is preferable.

    Article  PubMed  CAS  Google Scholar 

  47. Brandell RA, Mielnik A, Liotta D, et al.: AZFb deletions predict the absence of spermatozoa with testicular sperm extraction: preliminary report of a prognostic genetic test. Hum Reprod 1998, 13:2812–2815. This article documents the negative effect of a microdeletion of the Y-chromosome involving the AZFb region on subsequent TESE attempts.

    PubMed  CAS  Google Scholar 

  48. Rucker GB, Mielnik A, King P, et al.: Preoperative screening for genetic abnormalities in men with nonobstructive azoospermia before testicular sperm extraction. J Urol 1998, 160:2068–2071.

    Article  PubMed  CAS  Google Scholar 

  49. Jaroudi K, Coskun S, Hollanders J, et al.: Advanced surgical sperm recovery is a viable option for intracytoplasmic sperm injection in patients with obstructive or nonobstructive azoospermia. Fertil Steril 1999, 72:479–483.

    Article  PubMed  CAS  Google Scholar 

  50. Shulman A, Feldman B, Madgar I, et al.: In-vitro fertilization treatment for severe male factor: the fertilization potential of immotile spermatozoa obtained by testicular extraction. Hum Reprod 1999, 14:749–752.

    Article  PubMed  CAS  Google Scholar 

  51. Fischer R, Baukloh V, Naether OGJ, Schulze W: The concept of using spermatozoa from cryopreserved testicular tissue for ICSI in the treatment of severe male factor sterility in clinical application. Hum Reprod 1998, 13:96–97a.

    Google Scholar 

  52. Tesarik J, Mendoza C, Testart J: Viable embryos from injection of round spermatids into oocytes. N Engl J Med 1995, 333:525.

    Article  PubMed  CAS  Google Scholar 

  53. Mansour RT, Aboulghar MA, Serour K: Pregnancy and delivery after intracytoplasmic injection of spermatids into human oocytes. 1996. Middle East Fertil Soc 1996, 1:223–225.

    Google Scholar 

  54. Vanderzwalmen P, Zech H, Birkenfeld A, et al.: Intracytoplasmic injection of spermatids retrieved from testicular tissue: influence of testicular pathology, type of selected spermatids and oocyte activation. Hum Reprod 1997, 12:1203–1213.

    Article  PubMed  CAS  Google Scholar 

  55. Barak Y, Kogosowski A, Goldman S, et al.: Pregnancy and birth after transfer of embryos that developed from singlenucleated zygotes obtained by injection of round spermatids into oocytes. Fertil Steril 1998, 70:67–70.

    Article  PubMed  CAS  Google Scholar 

  56. Araki Y, Motoyama M, Yoshida A, et al.: Intracytoplasmic injection of late spermatids: a successful procedure in achieving childbirth for couples in which the male partner suffers from azoospermia due to deficient spermatogenesis. Fertil Steril 1997, 67:559–561.

    Article  PubMed  CAS  Google Scholar 

  57. Bernabeu R, Cremades N, Takahashi K, Sousa M: Successful pregnancy after spermatid injection. Hum Reprod 1998, 13:1898–1900.

    Article  PubMed  CAS  Google Scholar 

  58. Tesarik J, Bahceci M, Ozcan C, et al.: Restoration of fertility by in-vitro spermatogenesis. Lancet 1999b, 353:555–556.

    Article  PubMed  CAS  Google Scholar 

  59. Sofikitis N, Mantzavinos R, Loutradis D, et al.: Ooplasmic injections of secondary spermatocytes for non-obstructive azoospermia. Lancet 1998, 351:1177–1178.

    Article  PubMed  CAS  Google Scholar 

  60. Tesarik J, Greco E, Mendoza C: ROSI, instructions for use: 1997 update. Hum Reprod 1998, 13:519–523.

    PubMed  CAS  Google Scholar 

  61. Sousa M, Barros A, Takahashi K, et al.: Clinical efficacy of spermatid conception: analysis using a new spermatid classification scheme. Hum Reprod 1999, 14:1279–1286.

    Article  PubMed  CAS  Google Scholar 

  62. Amer M, Soliman E, El-Sadek M, et al.: Is complete spermiogenesis failure a good indication for spermatid conception? Lancet 1997, 350:116.

    Article  PubMed  CAS  Google Scholar 

  63. Zini A, O’Bryan MK, Magid MS, Schlegel PN: Immunohistochemical localization of endothelial nitric oxide synthase in human testis, epididymis, and vas deferens suggests a possible role for nitric oxide in spermatogenesis, sperm maturation, and programmed cell death. Biol Reprod 1996, 55:935–941.

    Article  PubMed  CAS  Google Scholar 

  64. Tesarik J, Greco E: Assisted reproduction for testicular failure: management of germ cell maturation arrest. Curr Opin Obstet Gynecol 1999, 11:283–288.

    Article  PubMed  CAS  Google Scholar 

  65. Yamamoto Y, Sofikitis N, Miyagawa I: Ooplasmic injections of rabbit round spermatid nuclei or intact round spermatids from fresh, cryopreserved and cryostored samples. Hum Reprod 1999, 14:1506–1515.

    Article  PubMed  CAS  Google Scholar 

  66. Sasagawa I, Tomaru M, Adachi Y, et al.: Simultaneous injection of round spermatid nuclei from mice and hamster oscillogen can initiate the normal development of mouse embryos. J Urol 1997, 158:2006–2008.

    Article  PubMed  CAS  Google Scholar 

  67. Lamb DJ, Schlegel PN: Bioethics and law forum. J Androl 1999, 20:454–455.

    PubMed  CAS  Google Scholar 

  68. Carpi A, Fabris FM, Gorini I, et al.: A percutaneous largeneedle aspiration biopsy technique for histologic examination of the testis in infertile patients. Fertil Steril 1999, 71:756–760.

    Article  PubMed  CAS  Google Scholar 

  69. Rammou-Kinia R, Anagnostopoulou I, Tassiopoulos F, Lykourinas M: Fine needle aspiration of the testis. Acta Cytol 1999, 43:991–998.

    PubMed  CAS  Google Scholar 

  70. Batra VV, Khadgawat R, Agarwal A, et al.: Correlation of cell counts and indices in testicular FNAC with histology in male infertility. Acta Cytol 1999, 43:617–623.

    PubMed  CAS  Google Scholar 

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  1. James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 E. 68th Street, Room F-907-A, 10021-4873, New York, NY, USA

    Peter T. K. Chan MD, CM, MSc, FRCS(C) & Peter N. Schlegel MD, FACS

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  1. Peter T. K. Chan MD, CM, MSc, FRCS(C)
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  2. Peter N. Schlegel MD, FACS
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Chan, P.T.K., Schlegel, P.N. Diagnostic and therapeutic testis biopsy. Curr Urol Rep 1, 266–272 (2000). https://doi.org/10.1007/s11934-000-0006-4

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