Роль методов хирургического получения сперматозоидов у пациентов с азооспермией в программах вспомогательных репродуктивных технологий (обзор литературы)

Обзор посвящен сравнению способов хирургического получения сперматозоидов: чрескожной и микрохирургической аспирации из придатка яичка, чрескожной аспирации и экстракции из яичка, в том числе микродиссекционной и мультифокальной. Эти методы позволяют мужчинам с азооспермией стать биологическими отцами благодаря использованию гамет, полученных из яичка или его придатка, в протоколах вспомогательных репродуктивных технологий. После лабораторной обработки материала сперматозоиды можно использовать для интрацитоплазматической инъекции и / или криоконсервации. В статье описаны история развития и технические нюансы этих хирургических вмешательств, выполнен анализ их преимуществ, недостатков и имеющихся ограничений. Упомянуты существующие лабораторные методы, применяемые для обработки полученных хирургическим путем сперматозоидов. Обсуждаются перспективы дальнейшего развития техники биопсии яичек, направленного на увеличение частоты обнаружения сперматозоидов.

1. Willott G.M. Frequency of azoospermia. Forensic Sci Int 1982;20(1):9–10. DOI: 10.1016/0379-0738(82)90099-8. PMID: 7095683.

2. Jarow J.P., Espeland M.A., Lipshultz L.I. Evaluation of the azoospermic patient. J Urol 1989;142(1):62–5. PMID: 2499695.

3. Temple-Smith P.D., Southwick G.J., Yates C.A. et al. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert and Embryo Transf 1985;2(3):119–22. DOI: 10.1007/BF01131497. PMID: 4056559.

4. Silber S., Ord T., Borrero C. et al. New treatment for infertility due to congenital absence of vas deferens. Lancet 1987;2(8563):850–1. DOI: 10.1016/S0140-6736(87)91031-2. PMID: 2889044.

5. Palermo G., Joris H., Devroey P., Van Steirteghem A.C. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340(8810):17–8. DOI: 10.1016/0140-6736(92)92425-F. PMID: 1351601.

6. Van Steirteghem A.C., Nagy Z., Joris H. et al. High fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod 1993;8(7):1061–6. DOI: 10.1093/oxfordjournals.humrep.a138192. PMID: 8408487.

7. Craft I., Bennett V., Nicholson N. Fertilising ability of testicular spermatozoa. Lancet 1993;342(8875):864. DOI: 10.1016/0140-6736(93)92722-6. PMID: 8104288.

8. Schoysman R., Vanderzwalmen P., Nijs M. et al. Pregnancy after fertilisation with human testicular spermatozoa. Lancet 1993;342(8881):1237. DOI: 10.1016/0140-6736(93)92217-H. PMID: 7901551.

9. Devroey P., Liu J., Nagy Z. et al. Normal fertilization of human oocytes after testicular sperm extraction and intracytoplasmic sperm injection. Fertil Steril 1994;62(3):639–41. DOI: 10.1016/S00150282(16)56958-1. PMID: 8062963.

10. Tournaye H., Camus M., Goossens A. et al. Recent concepts in the management of infertility because of non-obstructive azoospermia. Hum Reprod 1995;10 Suppl 1:115–9. DOI: 10.1093/humrep/10.suppl_1.115. PMID: 8592027.

11. Devroey P., Liu J., Nagy Z. et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in nonobstructive azoospermia. Hum Reprod 1995;10(6):1457–60. DOI: 10.1093/humrep/10.6.1457. PMID: 7593514.

12. Kahraman S., Ozgür S., Alataş C. et al. Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men. Hum Reprod 1996;11(4):756–60. DOI: 10.1093/oxfordjournals.humrep. a019249. PMID: 8671323.

13. Friedler S., Raziel A., Strassburger D. et al. Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997;12(7):1488–93. DOI: 10.1093/humrep/12.7.1488. PMID: 9262283.

14. Schlegel P.N., Palermo G.D., Goldstein M. et al. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology 1997;49(3):435–40. DOI: 10.1016/S00904295(97)00032-0. PMID: 9123710.

15. Rosenlund B., Kvist U., Plöen L. et al. A comparison between open and percutaneous needle biopsies in men with azoospermia. Hum Reprod 1998;13(5): 1266–71. DOI: 10.1093/humrep/13.5.1266. PMID: 9647558.

16. Tournaye H., Liu J., Nagy P.Z. et al. Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1996;11(1):127–32. DOI: 10.1093/oxfordjournals.humrep.a019004. PMID: 8671174.

17. Hauser R., Botchan A., Amit A. et al. Multiple testicular sampling in non-obstructive azoospermia – is it necessary? Hum Reprod 1998;13(11):3081–5. DOI: 10.1093/humrep/13.11.3081. PMID: 9853860.

18. Schlegel P.N., Su L.M. Physiological consequences of testicular sperm extraction. Hum Reprod 1997;12(8):1688–92. DOI: 10.1093/humrep/12.8.1688. PMID: 9308794.

19. Tash J.A., Schlegel P.N. Histologic effects of testicular sperm extraction on the testicle in men with nonobstructive azoospermia. Urology 2001;57(2):334–7. DOI: 10.1016/S0090-4295(00)00901-8. PMID: 11182348.

20. Craft I., Tsirigotis M., Courtauld E., Farrer-Brown G. Testicular needle aspiration as an alternative to biopsy for the assessment of spermatogenesis. Hum Reprod 1997;12(7):1483–7. DOI: 10.1093/humrep/12.7.1483. PMID: 9262282.

21. Schlegel P.N. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14(1):131–5. DOI: 10.1093/humrep/14.1.131. PMID: 10374109.

22. Okada H., Dobashi M., Yamazaki T. et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002;168(3):1063–7. DOI: 10.1016/S0022-5347(05)64575-2. PMID: 12187223.

23. Ramasamy R., Yagan N., Schlegel P.N. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65(6):1190–4. DOI: 10.1016/j.urology.2004.12.059. PMID: 15922422.

24. Tsujimura A., Matsumiya K., Miyagawa Y. et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 2002;17(11):2924–9. DOI: 10.1093/humrep/17.11.2924. PMID: 12407050.

25. Ishikawa T., Nose R., Yamaguchi K. et al. Learning curves of microdissection testicular sperm extraction for nonobstructive azoospermia. Fertil Steril 2010;94(3):1008–11. DOI: 10.1016/j.fertnstert.2009.03.108. PMID: 19427639.

26. Tsujimura A., Matsumiya K., Miyagawa Y. et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol 2004; 172(5 pt 1):1944–7. DOI: 10.1097/01.ju.0000142885.20116.60. PMID: 15540761.

27. Enatsu N., Miyake H., Chiba K. et al. Predictive factors of successful sperm retrieval on microdissection testicular sperm extraction in Japanese men. Reprod Med Biol 2015;15(1):29–33. DOI: 10.1007/s12522-015-0212-x. PMID: 29259419.

28. Schlegel P.N. Causes of azoospermia and their management. Reprod Fertil Dev 2004;16(5):561–72. DOI: 10.1071/RD03087. PMID: 15367371.

29. Jarow J., Sigman M., Kolettis P. et al. The management of obstructive azoospermia: AUA best practice statement. Linthicum (MD): American Urological Association, 2010.

30. De Braekeleer M., Dao T.N. Cytogenetic studies in male infertility: a review. Hum Reprod 1991;6(2):245–50. DOI: 10.1093/oxfordjournals.humrep.a137315. PMID: 2056021.

31. Brandell R.A., Mielnik A., Liotta D. et al. AZFb deletions predict the absence of spermatozoa with testicular sperm extraction: preliminary report of a prognostic genetic test. Hum Reprod 1998;13(10):2812–5. DOI: 10.1093/humrep/13.10.2812. PMID: 9804236.

32. Hopps C.V., Mielnik A., Goldstein M. et al. Detection of sperm in men with Y chromosome microdeletions of the AZFa, AZFb and AZFc regions. Hum Reprod 2003;18(8):1660–5. DOI: 10.1093/humrep/deg348. PMID: 12871878.

33. Craft I., Shrivastav P. Treatment of male infertility. Lancet 1994;344(8916):191–2. DOI: 10.1016/S0140-6736(94)92792-8. PMID: 7912782.

34. Lewin A., Weiss D.B., Friedler S. et al. Delivery following intracytoplasmic injection of mature sperm cells recovered by testicular fine needle aspiration in a case of hypergonadotropic azoospermia due to maturation arrest. Hum Reprod 1996;11(4):769–71. DOI: 10.1093/oxfordjournals.humrep.a019252. PMID: 8671326.

35. Morey A.F., Deshon G.E. Jr, Rozanski T.A., Dresner M.L. Technique of biopsy gun testis needle biopsy. Urology 1993;42(3):325–6. DOI: 10.1016/00904295(93)90625-K. PMID: 8379035.

36. Hovatta O., Moilanen J., von Smitten K., Reima I. Testicular needle biopsy, open biopsy, epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia. Hum Reprod 1995;10(10):2595–9. DOI: 10.1093/oxfordjournals.humrep.a135752. PMID: 8567777.

37. Bourne H., Watkins W., Speirs A., Baker H.W. Pregnancies after intracytoplasmic injection of sperm collected by fine needle biopsy of the testis. Fertil Steril 1995;64(2):433–6. DOI: 10.1016/S0015-0282(16)57747-4. PMID: 7615125.

38. El-Haggar S., Mostafa T., Abdel Nasser T. et al. Fine needle aspiration vs. mTESE in non-obstructive azoospermia. Int J Androl 2008;31(6):595–601. DOI: 10.1111/j.1365-2605.2007.00814.x. PMID: 17822417.

39. Enatsu N., Chiba K., Fujisawa M. The development of surgical sperm extraction and new challenges to improve the outcome. Reprod Med Biol 2015;15(3): 137–44. DOI: 10.1007/s12522-015-0228-2. PMID: 29259430.

40. Nicopoullos J.D., Gilling-Smith C., Almeida P.A. et al. Use of surgical sperm retrieval in azoospermic men: a meta-analysis. Fertil Steril 2004;82(3):691–701. DOI: 10.1016/j.fertnstert.2004.02.116. PMID: 15374716.

41. Donoso P., Tournaye H., Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? a systematic review. Hum Reprod Update 2007;13(6):539–49. DOI: 10.1093/humupd/dmm029. PMID: 17895238.

42. Deruyver Y., Vanderschueren D., Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2014;2(1):20–4. DOI: 10.1111/j.2047-2927.2013.00148.x. PMID: 24193894.

43. Gil-Salom M., Romero J., Mínguez Y. et al. Testicular sperm extraction and intracytoplasmic sperm injection: a chance of fertility in nonobstructive azoospermia. J Urol 1998;160(6 Pt 1):2063–7. DOI: 10.1016/S0022-5347(01)62243-2. PMID: 9817324.

44. Silber S.J., Nagy Z., Devroey P. et al. Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure. Hum Reprod 1997;12(11):2422–8. DOI: 10.1093/humrep/12.11.2422. PMID: 9436677.

45. Witt M., Richard J.R., Smith S.E. et al. The benefit of additional biopsy sites when performing testicular sperm extraction in non obstructive azoospermia. Fertil Steril 1997;1001:S79–80.

46. Schlegel P., Li S. Microdissection TESE: sperm retrieval in non-obstructive azoopsermia. Hum Reprod Update 1998;4(4):439. DOI: 10.1093/humupd/4.4.439. PMID: 9825858.

47. Esteves S.C., Miyaoka R., Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011;37(5):570–83. DOI: 10.1590/S167755382011000500002. PMID: 22099268.

48. Ghalayini I.F., Al-Ghazo M.A., Hani O.B. et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res 2011;3(3):124–31. DOI: 10.4021/jocmr542w. PMID: 21811543.

49. Amer M., Ateyah A., Hany R., Zohdy W. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Hum Reprod 2000;15(3):653–6. DOI: 10.1093/humrep/15.3.653. PMID: 10686214.

50. Bernie A.M., Mata D.A., Ramasamy R., Schlegel P.N. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril 2015;104(5):1099–103. DOI: 10.1016/j.fertnstert.2015.07.1136. PMID: 26263080.

51. Kovacic B., Vlaisavljevic V., Reljic M. Clinical use of pentoxifylline for activation of immotile testicular sperm before ICSI in patients with azoospermia. J Androl 2006;27(1):45–52. DOI: 10.2164/jandrol.05079. PMID: 16400077.

52. Foresta C., Garolla A., Bettella A. et al. Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod 1998;13(11):3090–3. DOI: 10.1093/humrep/13.11.3090. PMID: 9853862.

53. Har-Toov J., Eytan O., Hauser R. et al. A new power Doppler ultrasound guiding technique for improved testicular sperm extraction. Fertil Steril 2004;81(2):430–4. DOI: 10.1016/j.fertnstert.2003.07.020. PMID: 14967385.

54. Herwig R., Tosun K., Schuster A. et al. Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction. Fertil Steril 2007;87(5):1071–6. DOI: 10.1016/j.fertnstert.2006.10.010. PMID: 17173898.

55. Enatsu N., Miyake H., Chiba K., Fujisawa M. Identification of spermatogenically active regions in rat testes by using narrow band imaging system. Urology 2015;86(5):929–35. DOI: 10.1016/j.urology.2015.08.021. PMID: 26362950.

56. Ramasamy R., Sterling J., Fisher E.S. et al. Identification of spermatogenesis with multiphoton microscopy: an evaluation in a rodent model. J Urol 2011;186(6):2487–92. DOI: 10.1016/j.juro.2011.07.081. PMID: 22019169.

57. Ramasamy R., Sterling J., Manzoor M. et al. Full field optical coherence tomography can identify spermatogenesis in a rodent sertoli-cell only model. J Pathol Inform 2012;3:4. DOI: 10.4103/2153-3539.93401. PMID: 22439124.