Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia

Talas, Halit; Yaman, Önder; Aydos, Kaan

doi:10.1111/j.1745-7262.2007.00273.x

Cited by 23 publications

(11 citation statements)

References 18 publications

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“…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…”

Section: Discussionsupporting

confidence: 82%

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

Esteves¹,

Prudencio²,

Seol³

et al. 2014

Asian J Androl

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We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia (100%; adjusted odds ratio: 0.033; 95% CI: 0.007–0.164; P < 0.001). Live birth rates after sperm injections were lower in men with testicular failure (19.9%) compared with donor sperm (37.5%; adjusted OR: 0.377 (95% CI: 0.233–0.609, P < 0.001)) and obstructive azoospermia (34.2%; adjusted OR: 0.403 (95% CI: 0.241–0.676, P = 0.001). Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection (ICSI) are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.

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Section: Discussionsupporting

confidence: 82%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Esteves¹,

Prudencio²,

Seol³

et al. 2014

Asian J Androl

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show abstract

“…This requires the use of the operating microscope, which also helps in identifying the larger and more opaque tubules which might indicate sites of active spermatogenesis (73,78,80). High sperm retrieval rates (35%-77%) (10,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87) and relatively high quantities of retrieved sperm (160,000) from relatively small tissue fragments (72 mg) have been reported with this technique in NOA (78). Furthermore, this technique was associated with a reduced risk of testicular tissue damage with long-term ultrasound and endocrinologic evaluation (74,75,88).…”

Section: Testicular Biopsy-techniquesmentioning

confidence: 99%

Controversies in the management of nonobstructive azoospermia

Carpi¹,

Sabanegh²,

Mechanick³

2009

Fertility and Sterility

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“…Despite this controversy, repeated micro-TESE, if needed, may result in successful SR of approximately 82% enabling ICSI to be performed with fresh sperm. [38] In such cases, it is advisable to allow an interval of 6 months between retrievals as repeated procedures are more likely to be successful after 6 months compared with those performed within 6 months (8% vs. 25%).…”

Section: Discussionmentioning

confidence: 99%

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

Ashraf¹,

Singh²,

Raj³

et al. 2013

J Hum Reprod Sci

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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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Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia

Abstract: Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.

Cited by 23 publications

References 18 publications

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

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

Controversies in the management of nonobstructive azoospermia

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

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