World J Mens Health.  2019 Jan;37(1):55-67. 10.5534/wjmh.180077.

Testicular Fine-Needle Aspiration for Sperm Retrieval in Azoospermia: A Small Step toward the Technical Standardization

• Cito G
• Coccia ME
• Sessa F
• Cocci A
• Verrienti
• Picone R
• Fucci R
• Criscuoli
• Serni S
• Carini M
• Natali A

• KMID: 2429722
• DOI: http://doi.org/10.5534/wjmh.180077

Abstract

PURPOSE
The aim was to describe our preliminary experience performing testicular fine-needle aspiration (TEFNA) with a larger needle in infertile patients with obstructive azoospermia, and to provide a systematic literature review of the different testicular sperm aspiration techniques, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations.
MATERIALS AND METHODS
We prospectively collected data between March 2017 and June 2018. All men underwent bilateral TEFNA under analgo-sedation, using a larger disposable 18-gauge butterfly needle with 60 mL Luer-Lock syringe attached to it.
RESULTS
Thirty consecutive patients were enrolled. Median operative time was 16 minutes (interquartile range [IQR]: 12-30 minutes). No intraoperative complications occurred. Two/thirty patients (6.7%) reported postoperative adverse events: 1 patient had prolonged orchialgia, 1 patient presented scrotal hematoma. Successful sperm retrieval was found in 28/30 cases (93.3%). Median sperm concentration was 0.05 ×106/mL (IQR: 0.001-0.1 ×106/mL). Median total sperm motility was 10% (IQR: 0%-15%). In 20/30 men (66.7%) sperm retrieved was used for fresh intracytoplasmic sperm injection cycle, in 8/30 (26.7%) sperm cryopreservation was necessary, because on the day of sperm retrieval the female resulted not responder to ovarian stimulation. In this cases mean number of 3 (IQR: 1-4) bio system straws was cryopreserved.
CONCLUSIONS
TEFNA with 18-gauge needle proved to be a feasible, safe and effective treatment, even if future prospective studies will be addressed to clarify what type of azoospermia benefits from this procedure, and if a larger needle permits to improve Assisted Reproductive Technologies (ART) outcomes.

Keyword

Azoospermia; Biopsy, fine-needle; Infertility, male; Reproductive techniques; Sperm retrieval

MeSH Terms

Azoospermia*
Biopsy, Fine-Needle*
Butterflies
Cryopreservation
Female
Hematoma
Humans
Infertility, Male
Intraoperative Complications
Male
Needles
Operative Time
Ovulation Induction
Prospective Studies
Reproductive Techniques
Reproductive Techniques, Assisted
Sperm Injections, Intracytoplasmic
Sperm Motility
Sperm Retrieval*
Spermatozoa*
Syringes

Figure

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  Fig. 1 Testicular fine needle aspiration.

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  Fig. 2 Flow chart of the identified study.

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