睾丸组织Johnsen评分对非梗阻性无精子症患者取精成功率的预测

目的探讨睾丸组织病理学Johnsen评分是否可以作为非梗阻性无精子症患者取精成功的预测因素.方法选取2008年6月至2011年6月来院就诊的非梗阻性无精子症患者513例.所有患者均行详细的病史采集、体格检查、实验室检查、睾丸活检及活检组织病理学检查等.患者随访1~3年,其主要包括患者是否进一步行睾丸取精术以及取精的结果.结果总计有399例患者接受了活检同侧的睾丸取精术,其中睾丸穿刺取精成功112例,而穿刺取精失败的患者通过进一步接受睾丸显微取精术,成功取精44例.通过分析睾丸取精成功的预测因素后发现,当Johnsen评分≥7时,非梗阻性无精子症患者睾丸取精的成功率将显著提升.结论睾丸组织病理学Johnsen评分≥7可能是睾丸取精成功的预测因素.     

超声引导下非梗阻性无精子症活检取精前睾丸超声弹性成像应用价值初探

正临床上,70%的无精子症患者为非梗阻性无精子症(non-obstructive azoospermia,NOA)[1],其发病原因为睾丸生精功能的衰竭,虽然其睾丸生精功能差,但仍可能存在局灶性生精中心[2]。传统的睾丸活检取精术,精子获取成功率较低[3]。本研究使用超声弹性成像技术以及超声实时引导的方法介入男性NOA患者的睾丸活检取精过程,旨在探讨超声引导下NOA活检取精前睾丸超声弹性成像的应用价     

再次经皮睾丸细针抽吸术取精失败影响因素浅析

本中心自1998年9月至2005年4月底共458例(包括梗阻性和非梗阻性无精子症、严重的少精子、死精子症)病人进行睾丸取精加卵胞浆内单精子显微注射(ICSI)治疗。睾丸取精均采用经皮睾丸精子抽吸术     

睾丸精子获取和单精子卵胞浆内注射术治疗非梗阻性无精子症不育

目的　探讨非梗阻性无精子症患者外科获取睾丸精子的方法和意义。　方法　 4 9例非梗阻性无精子症患者行开放睾丸活检和诊断性睾丸精子获取术 (TESE) ,诊断性TESE有精子者至少 3个月后行单精子卵胞浆内注射 (ICSI)治疗。　结果　 12例 (2 4 .9% )诊断性TESE中发现精子 ,其中 3例为生精减少 ,2例为生精阻滞 ,7例为Sertoli细胞综合征。睾丸体积、血FSH水平和睾丸病理类型不能准确预测是否有精子。 8例行ICSI治疗 ,7例 (87.5 % )再次TESE获得睾丸精子行显微注射 ,3例获得临床妊娠。　结论　非梗阻性无精子症患者有必要行诊断性TESE确定睾丸内是否存在精子 ,获取睾丸精子结合ICSI可以有效治疗非梗阻性无精子症不育。     

非梗阻性无精子症三步法取精术及其临床意义(附73例报告)

目的:探讨非梗阻性无精子症应用三步法取精术获取睾丸精子的方法及其临床意义。方法:73例非梗阻性无精子症患者按步骤依次行睾丸细针抽吸术、睾丸活检术、睾丸显微取精术,并将每次获取的睾丸组织在倒置显微镜(×400)下寻找精子,如该步操作查见精子则终止手术,若未查找到则依次进行。同时取睾丸组织送病理行组织学检查。结果:73例患者行睾丸细针抽吸术,28例(38.4%)获得精子;行至睾丸活检术时,38例(52.1%)获得精子;行至睾丸显微取精术时,47例(64.4%)获得精子。病理学检查结果为唯支持细胞综合征型25例,其中10例查到精子,精子成熟阻滞型21例,其中14例查找到精子,精子发生低下型27例,其中23例查到精子。结论:三步法取精术能够有效地提高患者精子获得率;其精子获得率与睾丸组织学类型相关,其中精子发生低下型精子获得率较高。     

显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告)

目的:探讨显微镜下睾丸切开取精术应用于非梗阻性无精子症患者的疗效,以及显微取精术的手术适应症。方法:回顾性分析自2014年9月至2017年3月在我院接受显微镜下睾丸切开取精术的196例非梗阻性无精子症病例,统计取精成功率及其与年龄、睾丸体积、FSH、病因的相关性。结果:共87例(44.4%)患者成功手术取精;按手术成功取精与否分为阳性组与阴性组比较,患者年龄、睾丸大小及血FSH无统计学差异(P0.05);按病因分类,取精成功率分别为睾丸炎29例(100%)、隐睾下降术后16例(66.7%)、其他各种继发损害10例(55.6%)、AZFc区缺失3例(60.0%)、严重睾丸发育不良9例(40.9%)、特发性无精子症12例(21.4%)、Klinerfelter综合征8例(20.5%)、其他Y染色体异常0例(0%)。结论:显微镜下睾丸切开取精术是非梗阻性无精子症患者获取精子助孕的有效手段,其取精成功率与睾丸大小及FSH高低无关,存在明确病因的患者获精率高。     

非梗阻性无精子症患者外科取精技术的Meta分析

目的探讨非梗阻性无精子症(NOA)患者常用外科取精技术的获精率及其与睾丸病理类型的关系.方法通过计算机检索系统检索1997年至2011年发表的关于NOA患者外科取精的文献,并对所得文献进行Meta分析.结果在NOA患者睾丸进行外科取精,获精率最高的方法是显微切开睾丸取精术(MD)(51.9%);获精率与睾丸病理类型密切相关,精子发生功能低下(H S )、精子成熟阻滞(M A)和唯支持细胞综合征(SCO)患者的获精率分别为81.5%、48.8%和30.6%.结论 NOA患者行显微切开睾丸取精术获精率较高,不同病理类型中精子发生功能低下者获精率较高.     

Fas和FasL 系统在非梗阻性无精子症睾丸中的表达

目的：为探讨睾丸生精功能障碍与细胞凋亡的关系，研究Fas和FasL系统在非梗阻性无精子症睾丸支持、间质和生精细胞中的表达。方法：对20例非梗阻性无精子症患者行睾丸开放性活检，常规病理检查，按Johnson评分法评价精子发生和发生障碍的程度；采用免疫组化SABC法对睾丸支持、间质和生精细胞进行Fas和FasL表达的检测。结果：睾丸活检生精功能评为8分有14例，3分有2例，6、5、4和2分各有1例。在20例非梗阻性无精子症睾丸的间质、支持和生精细胞均有Fas和FasI。的表达；而支持细胞Fas和FasL的阳性和强阳性表达率明显高于间质和生精细胞。结论：非梗阻性无精子症的睾丸支持、间质及生精细胞Fas和FasL的高表达与精子生成障碍是一致的，非梗阻性无精子症可能与生殖细胞过度凋亡密切相关。     

睾丸穿刺取精术对非梗阻性无精子症患者性功能的影响

<正>非梗阻性无精子症(NOA)是排除了梗阻性因素的一类生精功能低下性疾病,这类患者不能产生精子或只产生极少量精子,导致精液中找不到精子。睾丸穿刺取精术(TESA)是诊断和治疗无精子症的重要手段,符合睾丸穿刺指征的NOA患者精子获取率约60%。随着卵细胞胞质内单精子注射(IC-SI)的应用,这部分NOA患者可获取睾丸精子治疗     

影响显微镜下睾丸切开取精成功率的因素

<正>据统计,人群中不育人口比例达到10%～15%,其中无精子症(azoospermia)患者大约占不育症患者10%左右,非梗阻性无精子症(non-obstructive azoospermia,NOA)约占无精子症的60%~([1]),而对于NOA患者来说,虽然体外射出的精液检测未见精子,但是大多数NOA患者仍然存在局灶性的生精功能~([2])。显微镜下睾丸切开取精术(mcrodessection testicular sperm extraction,MD)经过十余年的发展,与常规睾丸切开取精术及睾丸穿刺抽吸取精术等方法相比,手术创伤性小,取精的成功     

Microdissection testicular sperm extraction: Prediction, outcome, and complications

Testicular spermatozoa can be retrieved successfully by the testicular sperm extraction (TESE) procedure and used for intracytoplasmic sperm injection in cases of non-obstructive azoospermia (NOA). The successful application of TESE depends on the identification of seminiferous tubules containing spermatozoa; testicular tubules of patients with NOA are usually heterogeneous, and TESE may not always be successful in these patients. Microdissection TESE with an operative microscope is advantageous because larger, more opaque, and whitish tubules, presumably containing germ cells with active spermatogenesis, can be identified directly. This procedure is currently the best method for the certain identification of sperm, resulting in a high spermatozoa retrieval rate and minimal postoperative complications. The present review considers the surgical procedure, outcome, prediction for spermatozoa retrieval, and postoperative complications of microdissection TESE.     

Testicular sperm extraction for non-obstructive azoospermia: results with conventional and microsurgical techniques

Testicular sperm extraction (TESE) was performed on patients with non-obstructive azoospermia using the conventional or microdissection technique. First, conventional TESE was attempted on all patients. If the sperm was retrieved successfully, the TESE procedure was terminated. Microdissection TESE was indicated only for patients for whom the conventional sperm retrieval was unsuccessful. Sperm was successfully retrieved with conventional TESE from four (24%) of 17 patients with non-obstructive azoospermia. The remaining 13 patients underwent microdissection TESE and sperm was successfully retrieved from four of them. Application of the microdissection technique resulted in an improvement in sperm retrieval rates from 24% with conventional TESE to 48% when combined with the microdissection technique. None of the patients showed any acute or chronic complications after TESE. Intracytoplasmic sperm injection (ICSI) was performed on five of the eight patients with successful sperm retrieval and the partner of four of these patients became pregnant and progressed to delivery. These results indicate the usefulness of microdissection for improving the sperm retrieval rate in men with non-obstructive azoospermia.     

Microdissection testicular sperm extraction: an update

Patients with non-obstructive azoospermia (NOA) were once considered to be infertile with few treatment options due to the absence of sperm in the ejaculate. In the last two decades, the advent of intracytoplasmic sperm injection (ICSI), and the application of various testicular sperm retrieval techniques, including fine needle aspiration (FNA), conventional testicular sperm extraction (TESE) and microdissection testicular sperm extraction (micro-TESE) have revolutionized treatment in this group of men. Because most men with NOA will have isolated regions of spermatogenesis within the testis, studies have illustrated that sperm can be retrieved in most men with NOA, including Klinefelter''s syndrome (KS), prior history of chemotherapy and cryptorchidism. Micro-TESE, when compared with conventional TESE has a higher sperm retrieval rate (SRR) with fewer postoperative complications and negative effects on testicular function. In this article, we will compare the efficacy of the different procedures of sperm extraction, discuss the medical treatment and the role of testosterone optimization in men with NOA and describe the micro-TESE surgical technique. Furthermore, we will update our overall experience to allow counseling on the prognosis of sperm retrieval for the specific subsets of NOA.     

睾丸主要血管或睾丸网旁取精点与取精成功率不具显著相关性：以220例非梗阻性无精子症患者行传统或显微睾丸取精术为例

采用传统与显微睾丸取精术相结合方式对220例梗阻性无精症患者行精子提取术,如果传统手术方式未见精子即为阴性取精位点,然后选取2—3个阴性取精位点行显微睾丸取精术。术中通过手术显微镜评价睾丸血管系统,同时记录阳性取精位点与睾丸血供的关系。总的精子获取率为58-2％,早期应用传统手术方式精子获取率为46．8％,而后行显微睾丸取精术则精子获取率增加11．7％。故显微睾丸取精术的应用可显著增加精子获取率（P=0．017）,且在睾丸网或睾丸主要血管处并不能显著增加阳性取精位点。     

Sperm retrieval by microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in nonobstructive azoospermic patients with Klinefelter syndrome

Klinefelter syndrome is the most frequent chromosomal abnormality in patients with nonobstructive azoospermia. The development of advanced assisted reproductive techniques, such as testicular sperm extraction and intracytoplasmic sperm injection, has provided the possibility of biological fathering in nonobstructive azoospermic patients with Klinefelter syndrome. We aimed to evaluate our sperm retrieval rate by microdissection testicular sperm extraction and to analyse the intracytoplasmic sperm injection outcomes in these patients. Medical records of 110 nonobstructive azoospermic patients with Klinefelter syndrome were retrospectively reviewed. We found that the sperm retrieval rate by microdissection testicular sperm extraction is lower than published reports on other types of secretory azoospermia. The statistical analyses yielded that age, FSH and testosterone levels as predictive factors for successful sperm retrieval.     

Clinical analysis of patients with azoospermia factor deletions by microdissection testicular sperm extraction

Microdeletions of the azoospermia factor (AZF) locus on the Y chromosome have been implicated as a major genetic component of idiopathic male infertility, and the incidence of AZF deletions has been reported to be 15-20% in men with non-obstructive azoospermia (NOA). Numerous studies have described AZF deletion rates in patients with azoospermia; however, a clinical comparison of azoospermic patients with AZF deletion and those with no deletion has not been reported well. A new technique for testicular sperm extraction, microdissection testicular sperm extraction (TESE), has been used widely on NOA patients. Although testicular spermatozoa are reliably detected and retrieved from NOA patients by microdissection TESE, sperm retrieval rates for patients with AZF deletions are not well known. Therefore, characteristics of NOA patients with AZF deletion were investigated. Six of 60 patients (10%) who underwent microdissection TESE were found to have AZF deletions by genomic polymerase chain reaction. Testicular data, outcome of sperm retrieval and endocrinological profiles, were compared between patients with AZF deletions (n = 6) and those with no deletions (n = 54). Testicular size, varicocele rates and testicular histology were similar between the groups. Significant differences were not detected in the endocrinological profiles. Sperm retrieval rates were not significantly different between the groups. In conclusion, AZF deletions do not appear to confer specific characteristics to NOA patients.     

Therapeutic testis biopsy for sperm retrieval

PURPOSE OF REVIEW: The introduction of IVF and intracytoplasmic sperm injection revolutionized the treatment of male infertility by requiring a minimal number of sperm to achieve pregnancy. We describe the various methods for testicular sperm retrieval in different types of azoospermia. RECENT FINDINGS: Different techniques for surgical sperm retrieval are available, including testicular sperm aspiration, single, multisite and microdissection testicular sperm extraction, as well as percutaneous and microsurgical epididymal sperm aspiration. While these methods have similar retrieval outcomes in obstructive azoospermia, testicular sperm extraction procedures appear to be more beneficial in cases of nonobstructive azoospermia. A reliable algorithm for predicting the outcome of microdissection testicular sperm extraction using clinical parameters is still lacking, and may be difficult to develop, given the fact that this method is designed to detect and sample even minute areas of focal spermatogenesis. SUMMARY: A variety of surgical sperm retrieval procedures can be performed for the purpose of subsequent or simultaneous IVF/intracytoplasmic sperm injection. The decision regarding the type of procedure should be based on the type of azoospermia, specific clinical circumstances, as well as on the surgeon's preference and experience.     

Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval

PURPOSE: We determined the effect of prior biopsies with no sperm seen on the chance of sperm retrieval with microdissection testicular sperm extraction in men with nonobstructive azoospermia. MATERIALS AND METHODS: A total of 311 men with NOA underwent microdissection testicular sperm extraction. Of these patients 135 underwent no prior biopsies, 159 underwent 1 or 2 diagnostic testicular biopsies per testis and 17 underwent 3 or 4. The outcome measure studied was the success of sperm retrieval with microdissection testicular sperm extraction. Serum follicle-stimulating hormone and histopathological diagnosis were examined as predictive factors for sperm recovery. RESULTS: Spermatozoa were retrieved in 150 men by microdissection testicular sperm extraction (48%). The success of sperm retrieval in patients who underwent 3 to 4 biopsies (23%) was lower than the retrieval rate in patients who underwent no prior biopsies (56%) and 1 to 2 biopsies per testis (51%) (p = 0.04). When histopathology was considered, patients with Sertoli-cell-only diagnosis on prior diagnostic biopsy had lower retrieval rates compared to the group with no biopsies (p = 0.02). Men with maturation arrest and hypospermatogenesis had similar microdissection testicular sperm extraction sperm retrieval rates regardless of the number of prior biopsies. Spermatozoa recovery was independent of serum follicle-stimulating hormone. CONCLUSIONS: There is no threshold of prior negative biopsies that precludes the success of sperm retrieval using microdissection testicular sperm extraction. A limited number of testicular biopsies provide limited or no prognostic value for sperm retrieval with microdissection testicular sperm extraction.     

Updates on sperm retrieval techniques

In the most extreme form of male infertility, the male partner is azoospermic. The advent of in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) has revolutionized our ability to treat azoospermia in both obstructive and non-obstructive cases. In obstructive azoospermia, it allows paternity without microsurgical reproductive tract reconstruction and also in cases where the reproductive tract is unreconstructable. In men with non-obstructive azoospermia, microdissection testicular sperm extraction (mTESE) has allowed us to retrieve sperm in men with exceedingly low sperm production. The introduction of microsurgery in sperm retrieval improves sperm yields and quality while minimizing the chance of surgical morbidity.