Microdissection Testicular Sperm Extraction (micro-TESE) as a Sperm Acquisition Method for Men with Nonobstructive Azoospermia Seeking Fertility: Operative and Laboratory Aspects

Abstract

Introduction: Rare foci of sperm production may be found in up to 60% of men with nonobstructive azoospermia (NOA). Sperm production, if present, is minimal for sperm appearance in the ejaculate. Given that there are no treatment options to restore fertility, sperm retrieval is the only alternative to find testicular sperm than then can be used for in vitro fertilization (IVF). Among sperm acquisition methods, micro-TESE has higher success rates at obtaining sperm compared with testicular sperm extraction and testicular sperm aspiration.Materials and Methods: This video describes the operative aspects of micro-TESE, performed on an outpatient basis, in a man with NOA and history of cryptorchidism in whom orchidopexy was performed at age 6. The concept of micro-TESE is to identify areas of sperm production within the testes with the aid of optical magnification (15-25X) and based on the size and appearance of the seminiferous tubules (ST).Results: Intraoperative findings revealed homogeneous pattern of collapsed STs in which an area containing dilated STs was clearly identified and extracted. Testicular tissue was then processed in the IVF laboratory to allow sperm search. In this case, micro-TESE was successful at obtaining testicular sperm for intracytoplasmic sperm injection (ICSI). Surplus retrieved testicular spermatozoa not used for ICSI was cryopreserved. The operative time was 120 minutes, and intraoperative blood loss was negligible. Postoperatively, the patient recovered to his normal activities within 5 days and no complications were recorded except for minor testicular pain and scrotal swelling.Conclusion: Micro-TESE allowed the identification and extraction of sperm-containing STs with minimum tissue excision and marked reduction in time processing of testicular specimens for sperm injection.

Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility

“…The combination of these parameters was shown to be highly accurate to diagnose testicular failure 31. In this series, the SRR of 41.4% and complication rate of 6.3% are comparable to those reported in the literature 31516171826272829…”

“…Because the presence and geographic location of islets of normal spermatogenesis are unpredictable, several authors have proposed micro-TESE as a better method for SR in such cases 31516171826272829. Micro-TESE allows the identification of enlarged seminiferous tubules more likely to harbor sperm production.…”

“…If we failed to retrieve sperm by micro-TESE in one testis, the method was used contra-laterally in the same operation. We performed retrievals on an outpatient basis under local anesthesia combined with intravenous propofol infusion 1718. The extracted testicular fragments were immediately examined in the in vitro fertilization (IVF) laboratory 19.…”

“…Our methods for ovarian stimulation, oocyte collection, sperm injection, embryo culture and embryo transfer were previously described 18192021. In brief, we used recombinant gonadotropins for ovarian stimulation, in association with either gonadotropin-releasing hormone agonist or antagonist for LH surge suppression.…”

Novel concepts in male factor infertility: clinical and laboratory perspectives

“…Our experience with micro-TESE has also been reassuring [98]. The method rescues approximately one third of the cases that failed in previous non-microsurgical retrieval attempts and is particularly useful for men with NOA presenting the worst-case scenarios [99,100].…”