This week, we are presenting our latest research that says no to surgery at the annual meeting of the American Urological Association—a group of surgeons, no less. For this study, we decided to avoid operating on infertile testicles and simply plan to use as much ejaculated sperm as we could get. We had infertile men freeze consecutive semen samples until sufficient sperm were available for IVF-ICSI. Couples then proceeded to IVF-ICSI using a combination of fresh and frozen-thawed ejaculated sperm. What we learned surprised even us! Read more > http://theturekclinic.com/?p=8866

1. Clinical Outcomes using Ejaculated
Sperm in Cryptozoospermic Men
AUA 2013 Presentation
Paul J. Turek MD,
Director, The Turek Clinic
San Francisco, CA

2. Cryptozoospermia
Reliable ejaculated sperm?
No
IVF-ICSI
Bank Ejaculated Sperm
Yes
FNA Map
(1-3 mos)
MicroTESE
(<1 mos)
Treat/Improve(
3-6 mos)
Testis Testis/Ejaculate Ejaculate Ejaculate
The Turek Clinic
Approach

3. Cryptozoospermia
Reliable ejaculated sperm?
2001-2003 UCSF
N=15 men with
•Severe oligospermia
•Complete asthenospermia
Zenke et al, ASRM, 2003
Parameter Mean Range
Testis volume R: 15.6mL; L: 14 mL L:4-20mL; R: 6-20mL
Total Testosterone 305 ng/mL 170-450 ng/mL
FSH 9.7 mIU/mL 2-16.7 mIU/mL
Ejaculate volume 2.7 mL 2-4.5mL
Sperm concentration 10 sperm to 3 million/mL
Motility 0-50%

4. Cryptozoospermia
Reliable ejaculated sperm?
2001-2003 UCSF
N=15 men with
Severe oligospermia
Complete asthenospermia
Zenke et al, ASRM, 2003

5. Reliable ejaculated sperm?
Yes
2010-2012 The Turek Clinic
N=40 men with
cryptozoospermia
Mean age=38 years
No sperm
Nonmotile
Motile
Motile and
nonmotile
10%25%
60%
5%
Hagerty et al, 2012
•85% of men able to
bank sperm
•40% sample-to-
sample variability

6. Reliable ejaculated sperm?
Yes
2010-2012 The Turek Clinic
N=34 men banking sperm
Mean age=38 years
Hagerty et al, 2012
•Mean 3.25samples
banked/pt
•Range 1-7 ejaculates
•Mean TMC banked/
ejaculate=79,633
motile sperm
•TMC range/ejaculate:
1 to 1.19 million
0
5
10
15
20
25
30
35
%
Pts
Mean TMC/banked ejaculate

7. Hagerty et al, 2012
Reliable ejaculated sperm?
No
Treat/Improve(
3-6 mos)
•2010-2012 The Turek Clinic
•N=40 men with
cryptozoospermia
•23/40 received therapy
(57%) before banking
•Among treated:
3/23 (13%) varicocele
20/23 (87%) medical
No Rx Yes Rx
66,000
28,600
Mean Banked TMC/Ejaculate

8. Cryptozoospermia
IVF-ICSI
•2010-2012
•N=40 men with
cryptozoospermia
•To date, 13/40 couples to IVF-ICSI
•Sperm source:
Fresh
Ejaculate
77%
Thawed
Ejaculate
8%
mTESE
15% •Mean female age 32.4 yrs
(27-41 yrs)
•60% 2PN rate
•46% (6/13) ongoing preg. rate
Hagerty et al, 2012

9. Reliable ejaculated sperm?
No
FNA Map
(1-3 mos)
MicroTESE
(<1 mos)
Treat/Improve(
3-6 mos)
Unilateral TESA (n=3)
Bilateral TESA (n=2)
Bilateral TESE (n=1)
Unil. Micro-TESE (n=2)
2001-2003 UCSF
N=15 men with
Severe oligospermia
Complete asthenospermia
N=8 (61%) needed sperm
retrieval

10. Testis sperm
aspiration
(TESA)
Testis sperm
extraction
(TESE)
Testis
microdissection
(MicroTESE)
Less Invasive More Invasive
Not all sperm retrieval procedures are the same

11. Sperm Sourceand ICSI Fertilization Rates
NOA-Testis sperm NOA-Cryptozoospermia
X
X
What kind of performance differences do we expect
Between ejaculated and testicular sperm…none really.

12. Cryptozoospermia
•Most men (85%) will be able to bank ejaculated sperm.
•Sample to sample variability in ejaculates is high (40%)
•Medical or surgical therapy may not improve
ejaculated sperm counts.
•Ejaculated sperm (fresh or thawed) is available for most
men (85%) at IVF-ICSI
•IVF fertilization and pregnancy rates are reasonable
with ejaculated sperm.
•Be kind to your patients (and avoid mTESE).