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Therapie der Azoospermie

Operative Spermiengewinnung (MESA, TESE, Mikro-TESE)

Treatment of azoospermia

Surgical sperm retrieval (MESA, TESE, micro-TESE)

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Zusammenfassung

Die Einführung der intrazytoplasmatischen Spermatozoeninjektion (ICSI) in das Behandlungsspektrum reproduktionsmedizinischer Therapieoptionen vor mehr als 15 Jahren ermöglichte eine Vaterschaft von Männern auch mit schwersten Spermatogenesestörungen Diesen Männern können heute mit unterschiedlichen Techniken operativ Spermatozoen für die Durchführung einer ISCI-Behandlung entnommen werden. Die operative Spermatozoenentnahme bietet sich auch bei Männern mit Verschlussazoospermie mit mikrochirurgisch nicht rekonstruierbaren Verhältnissen an. Verschiedene technische Möglichkeiten der Spermatozoenentnahme sind entwickelt worden, wobei die mikrochirurgische epididymale Spermatozoenasservierung (MESA) und die testikuläre Spermatozoenextraktion (TESE) die heute am meisten verwendeten Techniken sind. Auch perkutane Verfahren stehen zur Verfügung (z. B. TeFNA), haben sich aber gegenüber den primär chirurgischen Techniken wenig durchgesetzt. Durch die etablierten Möglichkeiten der Kryokonservierung von entnommenen Spermatozoen können durch einen einzigen chirurgischen Eingriff Spermatozoen für diverse ICSI-Zyklen entnommen werden.

Abstract

The introduction of intracytoplasmic sperm injection (ICSI) into the spectrum of assisted reproductive technologies has offered men who suffer from severe disorders of spermatogenesis and azoospermia the possibility of fathering a child. Different surgical techniques can be used to extract spermatozoa from these men from either the epididymis and/or the testis. Surgical sperm retrieval offers a treatment for patients with testicular and/or obstructive azoospermia in cases where microsurgical refertilization is not an option or has already failed. Among surgical techniques that have been explored over the years, microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) have become the most popular. Percutaneous techniques (such as TEFNA) are available but have disadvantages versus open surgical procedures. Together with cryopreservation of extracted spermatozoa, these techniques facilitate retrieval of spermatozoa for several ICSI attempts by a single surgical intervention.

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Literatur

  1. Foresta C, Zorzi M, Galeazzi C, Rossato M (1995) Functional and structural characteristics of human epididymal spermatozoa retrieved by percunaneous aspiration. Int J Androl 18:197–202

    Article  CAS  PubMed  Google Scholar 

  2. Girardi SK, Schlegel PN (1996) Microsurgical epididymal sperm aspiration. Urol Clin North Am 4:55–66

    Google Scholar 

  3. Heidenreich A, Altmann P, Engelmann U (2000) Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmatic sperm injection. Eur Urol 37:609–614

    Article  CAS  PubMed  Google Scholar 

  4. Köhn FM, Schroeder-Printzen I, El Mulla KF et al (1996) Andrological work up of patients undergoing microsurgical epididymal sperm aspiration or testicular sperm extraction. Andrologia 1(Suppl 28):77–81

    Google Scholar 

  5. Levine LA, Lisek EW (1998) Successfull sperm retrieval by percutaneous epididymal and testicular sperm aspiration. J Urol 159:437–440

    Article  CAS  PubMed  Google Scholar 

  6. Palermo G, Joris H, Devroey P, Steirteghem AC van (1992) Pregnancies after intracytoplasmic injection of a single spermatozoon into an oocyte. Lancet 340:17–18

    Article  CAS  PubMed  Google Scholar 

  7. Pantke P, Bergmann M, Steger K et al (2008) Testicular sperm retrieval in azoospermic men. Eur Urol 7(Suppl):703–714

    Article  Google Scholar 

  8. Ramasamy R, Yagan N, Schlegel PN (2005) Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 65:1190–1194

    Article  PubMed  Google Scholar 

  9. Schroeder-Printzen I, Ludwig M, Köhn F, Weidner W (2000) Surgical therapy in infertile men with ejaculatory ductobstruction: technique and outcome of a standardized surgical approach. Hum Reprod 15:1364–1368

    Article  CAS  PubMed  Google Scholar 

  10. Schroeder-Printzen I, Zumbé J, Bispink L et al (2000) Microsurgical apididymal sperm aspiration: aspirate analysis and straws available after cryopreservation in patients with non-reconstructable obstructive azoospermia. Hum Reprod 15:2531–2535

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  12. Silber SJ, Nagy ZP, Liu J et al (1994) Conventional in-vitro fertilization versus intracytoplasmatic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 9:1705–1709

    CAS  PubMed  Google Scholar 

  13. Silber SJ (2000) Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod 15:2278–2284

    Article  CAS  PubMed  Google Scholar 

  14. Steger K, Fink L, Failing K et al (2003) Decreased protamine-1 transcript levels in infertile men. Mol Hum Reprod 9:331–336

    Article  CAS  PubMed  Google Scholar 

  15. Steger K, Wilhelm J, Konrad L et al (2008) Both protamine-1 to protamine 2-mRNA ratio and Bc12 mRNA content in testicular spermatids and ejaculated spermatozoa discriminate between fertile and infertile men. Hum Reprod 23:112–116

    Google Scholar 

  16. Tarlatzis BC, Bili H (1998) Survey on intracytoplasmatic sperm injection: reportfrom the ESHRE ICSI Task Force. Hum Reprod 13(Suppl 1):165–177

    Article  PubMed  Google Scholar 

  17. Tournaye H, Devroey P, Liu J et al (1994) Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a resultof congenital bilateral absence of the vas deferens. Fertil Steril 61:1045–1051

    CAS  PubMed  Google Scholar 

  18. Tournaye H, Merdad T, Silber S et al (1999) No differences in outcome after intracytoplasmatic sperm injection with fresh or with frozen-thawed epididymal spermatozoa. Hum Reprod 14:90–95

    Article  CAS  PubMed  Google Scholar 

  19. Tsujimura A, Matsumiya K, Miyagawa Y et al (2002) Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 17:2924–2929

    Article  CAS  PubMed  Google Scholar 

  20. Tsujimura A, Miyagawa Y, Takao T et al (2006) Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol 175:1446–1449

    Article  PubMed  Google Scholar 

  21. Vogt PH (1998) Human chromosome deletions in Yg11 AZF candidate genes and male infertility. History and update. Mol Hum Reprod 4:739–744

    Article  CAS  PubMed  Google Scholar 

  22. Weidner W, Schroeder-Printzen I, Weiske WH et al (1995) Microsurgical aspects of the treatmentof azoospermia. Int J Androl 18(Suppl 2):63–66

    Article  PubMed  Google Scholar 

  23. Weidner W, Krause W, Ludwig M (1999) Relevance of male accessory gland infection for subsequentfertility with special focus on prostatitis. Hum Reprod 5:42

    Google Scholar 

  24. Zitzmann M, Nordhoff V, Schönfeld V von et al (2006): Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue. Fertil Steril 86:339–347

    Article  CAS  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Takeda, Bayer Health Care, Bayer Vital, Lilly Deutschland GmbH.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Straße 7, 35385, Gießen, Deutschland

    T. Diemer, A. Hauptmann & W. Weidner

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  1. T. Diemer
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  2. A. Hauptmann
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  3. W. Weidner
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Corresponding author

Correspondence to T. Diemer.

Additional information

Dieser Artikel ist eine überarbeitete Version (Update) der im Urologe A im Jahre 2007 publizierten Arbeit (CME-Review): Diemer et al., „Operative Spermatozoengewinnung“ [Urologe A 46(7): 789–798; quiz 799]. Textteile und Abbildungen wurden dabei fragmentweise übernommen. Unterstützung durch die Klinische Forschergruppe DFG KFo 181 „Male factor Infertility due to impaired Spermatogenesis“.

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Diemer, T., Hauptmann, A. & Weidner, W. Therapie der Azoospermie. Urologe 50, 38–46 (2011). https://doi.org/10.1007/s00120-010-2442-1

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