Methods and efficacy of processing testicular sperm samples in obstructive and non-obstructive azoospermia: a systematic review
Intracytoplasmic sperm injection (ICSI) is a cornerstone in managing male infertility, especially in obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), necessitating sperm retrieval via testicular sperm extraction (TESE) or microdissection TESE (mTESE). However, the varied post-s...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MRE Press
2024-11-01
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| Series: | Journal of Men's Health |
| Subjects: | |
| Online Access: | https://oss.jomh.org/files/article/20230928-100/pdf/JOMH2024053101.pdf |
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| Summary: | Intracytoplasmic sperm injection (ICSI) is a cornerstone in managing male
infertility, especially in obstructive azoospermia (OA) and non-obstructive
azoospermia (NOA), necessitating sperm retrieval via testicular sperm extraction
(TESE) or microdissection TESE (mTESE). However, the varied post-sperm extraction
processing methods pose uncertainty regarding optimal approaches. To address
this, a systematic review following preferred reporting items for systematic
review and meta-analysis protocols (PRISMA-P) guidelines was conducted,
identifying 16 relevant studies. These studies exhibited significant
heterogeneity in methodologies and outcomes, with mechanical preparation and
enzymatic digestion being the primary techniques investigated. Mechanical
methods, including shredding, mincing, vortexing and crushing, yielded varying
sperm counts per 100 mg of tissue, with mincing showing promise in NOA cases.
Enzymatic digestion, particularly with collagenase type IV, also showed
effectiveness, though inconsistently. Additionally, techniques such as
microfluidics and magnetic levitation showed potential for improving sperm
retrieval efficiency. However, the lack of standardization in outcomes and
reporting impedes the establishment of best practice protocols. While collagenase
type IV with elastase seemed promising for OA samples and microfluidics for NOA
cases, further studies with standardized methodologies and outcomes are
necessary. Assessment of DNA damage and comparisons of ICSI success rates between
processing methods are crucial for informed clinical practice. In conclusion,
optimizing sperm quantity and quality for ICSI necessitates standardized
methodologies and outcomes, with microfluidics and collagenase type IV with
elastase showing promise pending further validation through well-designed
studies. |
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| ISSN: | 1875-6867 1875-6859 |