clinical management of men with nonobstructive azoospermia - chances of harvesting sperm
TRANSCRIPT
REPRODUCTIVE ANDROLOGY SURGERY WORKSHOP III 17-21 January 2016 – Reproductive Medicine Unit – Jahra Hospital
KUWAIT
CLINICAL MANAGEMENT OF MEN WITH NONOBSTRUCTIVE AZOOSPERMIA Lesson 2: Chances of Harvesting Sperm
Dr Sandro ESTEVES Medical and Scientific Director ANDROFERT - Andrology & Human Reproduction Clinic Campinas, Brazil
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2016
ANDROFERT
Challenges faced by health professionals providing care for men with SF
§ Counseling about the chances of harves:ng sperm within the tes:cle
§ Usefulness of any medical interven:on before sperm retrieval
§ Which sperm retrieval method to apply § Reproduc:ve poten:al of retrieved gametes in ICSI treatment
§ Health of offspring
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 3 2016
ANDROFERT
Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83
About 40-50% of men with SF have residual spermatogenesis within the testis
§ Not enough for sperm to appear in ejaculate
§ 600-800 seminiferous tubules § Goal is identify site of
production and retrieve sperm for ICSI
§ Geographic location unpredictable
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 4 2016
ANDROFERT
Esteves et al Fertil Steril 2010; Raman & Schlegel J Urol 2003; Hopps et al. Hum Reprod 2003; Damani et al JCO 2002
Etiology category Success in harvesting sperm
Cryptorchidism 52-74% Post-infection 67% Torsion/Trauma ~50% Post-chemotherapy/RT 25-75% Genetic 0-70% Idiopathic 50-60%
Etiology cannot determine whether or not sperm will be found within the testis
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2016
ANDROFERT
FSH levels Testosterone levels
Testicular volume
elec:ng candidates for SR Can biomarkers predict SR success?
Diagnostic markers reflect global testicular function but not the presence of a site of
active spermatogenesis
Verza Jr & Esteves. Fertil Steril 2011; 96 (Suppl.): S53
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 6 2016
ANDROFERT
Biopsy helpful for counseling but does not provide definitive proof of whether sperm will be found; may jeopardize future retrieval attempts
100%
40.3% 19.5%
Hypospermatogenesis Maturation Arrest Sertoli-cell only
Presence of sperm within the testicle (N=357)
Esteves & Agarwal. Asian J Androl 2014; 16: 642
Testicular histopathology
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 7 2016
ANDROFERT
Genetic assessment of AZF region within the Y chromosome helpful to determine the chances of
finding testicular sperm
Hamada et al. Clinics 2013; 68 (Suppl 1): 39-60; Krausz et al. Andrologia 2014; 2: 5-19
Microdeletions within AZF region found in up to 15% of men with SF
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2016
ANDROFERT
Multiplex-PCR molecular diagnosis of YCMD
#4 Normal male #5 AZFb microdeletion #6 AZFc microdeletion
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 9 2016
ANDROFERT
✕✕✕nil nil ~50%
Hamada et al. 2013; Krausz et al. 2014; Esteves et al. 2013
Complete AZFa, AZFb or AZFa+b microdeletions unfavorable prognosis;
SR not recommended
Chances of finding sperm
within the testis
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 10 2016
ANDROFERT
Key Messages – Day 2 Chances of Harvesting Sperm
ANDROFERT
§ Diagnostic parameters not accurate to determine if residual spermatogenesis exists
§ YCMD screening mandatory to “deselect” men with AZFa-b deletions from SR
§ Male offspring of fathers with AZFc microdeletions will inherit the Yq deletion (infertility)
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 11 2016
ANDROFERT
Thank you
This presenta:on is available at hCp://www.slideshare.net/
sandroesteves
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