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Jens Fedder [1; 2] and Niels Marcussen [1; 3] and Maja D. K. Fedder [1; 2] and Birte Engvad [1; 3]

Academic Editor: Mohamed Elshazly

1, Centre of Andrology, Odense University Hospital, Odense, Denmark, ouh.dk

2, Fertility Clinic, Odense University Hospital, Odense, Denmark, ouh.dk

3, Department of Pathology, Odense University Hospital, Odense, Denmark, ouh.dk

Received May 19, 2017; Accepted Aug 22, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Since the early nineties, large and increasing numbers of infertile couples have had Intracytoplasmic Sperm Injection (ICSI) using sperm retrieved from the testis or epididymis. In many azoospermic men, particularly men with obstructive azoospermia (OA), testicular sperm retrieval is performed as a randomly located open biopsy using a scalpel [1, 2]; testicular sperm aspiration (TESA) using a needle, gauge 19–26 [3, 4]; or testicular sperm extraction (TESE) using a TruCut “gun” needle, gauge 14 or 18 [5, 6]. In some cases with nonobstructive azoospermia or cryptozoospermia, opaque seminiferous tubules may be isolated by open surgery using loop glasses (magnification ×4) [7] or microdissection TESE (mTESE; magnification ×25) [8] in order to minimize vascular injury and the amount of testis tissue removed. In some men with Klinefelter’s syndrome (KS), unilateral subcapsular orchiectomy may be used as an alternative to micro-TESE [9].

Several studies have shown that children born after ICSI using testicular or epididymal sperm are healthy and the risk of malformations, except from hypospadias and cryptorchidism, is not increased [10, 11]. In men with OA, sperm retrieval rates are close to 100% even after repeated procedures [12, 13]. However, when TESE was performed at an earlier procedure in men undergoing repeated sperm retrieval, the pregnancy rate was only 27% (although sperm were found in all cases) compared to a 48% pregnancy rate where epididymal sperm were retrieved and used the previous time [12], suggesting that operations on the testis may impair sperm function.

An association between testicular fibrosis and reduced semen quality has been found in cattle [14]. Studies using rat models suggest that multiple needle biopsies cause larger irreversible scar tissue formations than TruCut biopsies do [15]. However, rats and...

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