Localization of Sperm During Microdissection Testicular Sperm Extraction in Men with Nonobstructive Azoospermia

Ramasamy, Ranjith; Reifsnyder, Jennifer; Husseini, Jad S.; Eid, Pierre Alexandre; Bryson, Campbell

doi:10.1016/j.juro.2012.09.031

Cited by 39 publications

(38 citation statements)

References 19 publications

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“…Two of the men who underwent a bilateral micro-TESE had no spermatozoa identified intra-operatively but were subsequently found to have spermatozoa on final assessment (and had successful ICSI). These data indicate that a negative intra-operative result after unilateral micro-TESE carries a poor prognosis (a 16% final sperm retrieval rate after bilateral micro-TESE) and are in keeping with prior reports (Ramasamy et al, 2011(Ramasamy et al, , 2013. Moreover, our data also indicate that a negative intra-operative result after a complete bilateral micro-TESE also carries a very poor prognosis [a 6% (2/36) final sperm retrieval rate] as previously reported (Ramasamy et al, 2011(Ramasamy et al, , 2013).…”

Section: Discussionsupporting

confidence: 91%

“…An intra-operative assessment of sperm recovery during micro-TESE is performed in many centers as it decreases the amount of testicular tissue extracted and may help avoid a contra-lateral micro-TESE (Ramasamy et al, 2013). However, it remains unclear to date whether there is a minimum number and quality (motile vs. non-motile) of spermatozoa that needs to be identified intra-operatively before one considers that the micro-TESE is successful.…”

Section: Discussionmentioning

confidence: 99%

“…As part of the procedure, most centers perform an immediate (intra-operative) microscopic assessment of the extracted testicular tissue. This will help to guide the surgeon as to whether he/she should continue extracting tissue in the ipsilateral and/or contra-lateral testis or terminate the procedure (Tsujimura et al, 2002;Turunc et al, 2010;Ramasamy et al, 2011Ramasamy et al, , 2013.…”

Section: Introductionmentioning

confidence: 99%

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Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

Alrabeeah

Doucet²,

Boulet³

et al. 2015

Andrology

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SUMMARYThe minimum sperm count and quality that must be identified during microdissection testicular sperm extraction (micro-TESE) to deem the procedure successful remains to be established. We conducted a retrospective study of 81 consecutive men with nonobstructive azoospermia who underwent a primary (first) micro-TESE between March 2007 and October 2013. Final assessment of sperm recovery [reported on the day of (intracytoplasmic sperm injection) ICSI] was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a unilateral (with limited or complete microdissection) or bilateral micro-TESE was guided by the intra-operative identification of sperm recovery (≥5 motile or non-motile sperm) from the first testicle. Overall, sperm recovery was successful in 56% (45/81) of the men. A unilateral micro-TESE was performed in 47% (38/81) of the men (based on intra-operative identification of sperm) and in 100% (38/38) of these men, spermatozoa was found on final assessment. In 42% (16/38) of the unilateral cases, a limited microdissection was performed (owing to the rapid intraoperative identification of sperm). The remaining 43 men underwent a bilateral micro-TESE and 16% (7/43) of these men had sperm identified on final assessment. The cumulative ICSI pregnancy rates (per cycle started and per embryo transfer) were 47% (21/45) and 60% (21/35), respectively, with a mean (AESD) of 1.9 AE 1.0 embryos transferred. The data demonstrate that intra-operative assessment of sperm recovery can correctly identify those men that require a unilateral micro-TESE. Moreover, the rapid identification of sperm recovery can allow some men to undergo a limited unilateral micro-TESE and avoid the need for complete testicular microdissection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

Alrabeeah

Doucet²,

Boulet³

et al. 2015

Andrology

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“…A review of the literature shows the micro-TESE SRR to be between 38-63% in NOA patients [6][7][8][9] . Given the SRR results from this study particularly in men with normal range FSH ≤ 10IU/L, we found that TESA in our experience had similar results compared to micro-TESE.…”

Section: Discussionmentioning

confidence: 99%

“…TESA also requires less operating time than the more technically challenging micro-TESE [7] . Most cases of micro-TESA can take hours to obtain spermatozoa.…”

Section: Discussionmentioning

confidence: 99%

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

Chow

Levine

2017

JGS

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Objective: To evaluate the sperm-retrieval rate (SRR) of testicular sperm aspiration (TESA) for men with presumed non-obstructive azoospermia (NOA) without prior genetic testing or testicular biopsies and to examine the correlation of successful sperm retrieval and FSH level. Patients and Methods:The complete records of 148 azoospermic men without clinical evidence of obstructive etiologies who underwent TESA from 1999 -2016 were reviewed. Preoperative diagnostic biopsies were not obtained and thus men with presumed NOA were defined as having no evidence of obstruction by history or physical examination. Preoperative FSH and testosterone were obtained for all patients. Two subgroups of NOA were evaluated (Group 1 with FSH > 10 IU/L and Group 2 with FSH ≤ 10). Results: Of our 148 patients, we identified 66 (45%) in Group 1 and 82 (55%) in Group 2. Sperm was successfully obtained from 19/66 (28.7%) in Group 1 and 56/82 (68%) in Group 2. Average FSH for Group 1 and Group 2 were 20.4 (10 -66) IU/L and 4.6 (1.1 -9.4) IU/L respectively. There were no postoperative adverse events including prolonged pain, infection, hematoma, hydrocele or testicular atrophy. Conclusion: TESA appears to offer a reasonably high likelihood of viable sperm retrieval in men with NOA. Given the higher level of SRR for men with presumed NOA with normal range of FSH (≤ 10 IU/L), we recommend that TESA should be considered the initial approach to retrieve sperm in this population as it is a quicker, easier, less invasive and likely a less costly approach to micro-TESE.

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The azoospermic patient

Sharif

Al-Rawahneh

2021

Assisted Reproduction Techniques

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Localization of Sperm During Microdissection Testicular Sperm Extraction in Men with Nonobstructive Azoospermia

Abstract: More than a third of the men with nonobstructive azoospermia required complete microdissection of the testes to identify sperm. Sperm were found on the contralateral side in up to 8% of the men in whom no sperm were identified in the initial testis.

Cited by 39 publications

References 19 publications

Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

The azoospermic patient

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