CONTEXT:Non-obstructive azoospermia (NOA) is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR) coupled with intracytoplasmic sperm injection (ICSI) is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE) has been applied with encouraging results.AIMS:We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR.SETTINGS AND DESIGN:Case series of men with NOA treated in a tertiary healthcare center.MATERIALS AND METHODS:An Assisted Reproductive Technology (ART) facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP). Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes.STATISTICAL ANALYSIS:Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR.RESULTS:The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%.CONCLUSIONS:We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF) laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.

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Background: Oocyte quality is instrumental in the development of early embryos and may account for the difference in the rates of fertilization, cleavage, implantation and pregnancy outcome. Centrally located cytoplasmic granularity is a rare morphological feature that can be observed in certain cases. We conducted this study with the sole aim to compare the pregnancy outcomes from embryo derived exclusively from oocytes with dense central granularity with embryos derived from oocytes with normal morphology in intracytoplasmic sperm injection (ICSI)-freeze- all cycles.Methods: A retrospective case control study performed during a period of 1 year and 10 months from Jan 2018-Oct 2019 at craft hospital and research centre India; a tertiary heath care centre. The 62 infertile women undergoing ICSI FET cycle with oocyte cohort having all central granularity oocytes were included as study participants after fulfilling the inclusion and exclusion criteria. The 200 women undergoing ICSI- frozen embryo transfer (FET with normal morphology oocyte were taken. Implantation rate and clinical pregnancy rate were evaluated as primary outcomes. Ongoing pregnancy rate, live birth rate, fertilization rate and top-quality embryo were taken as secondary outcomes.Results: The implantation rate and clinical pregnancy rate was 21.48% and 40.33% in study group compared to 35.012% and 58.5% respectively in control group which was statistically significant (p=0.002; 0.012 respectively).Conclusions: Presence of dense central granularity in the oocyte can be used to predict poor ART outcome in terms of low implantation and clinical pregnancy rates.