Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia

Abstract

SUMMARYSeveral studies support of the use of testicular rather than ejaculated spermatozoa for intracytoplasmic sperm injection (ICSI) in couples with virtual azoospermia or cryptozoospermia, although this approach remains controversial. We sought to evaluate sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia. We conducted a retrospective study of 24 consecutive micro-TESEs in men with cryptozoospermia. We also evaluated the outcomes of seven consecutive TESAs (testicular sperm aspiration) in cryptozoospermic men during the same time period (January 2007 and September 2014). Micro-TESE and TESA were performed on the day prior to ICSI. Final assessment of sperm recovery (reported on the day of ICSI) was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a unilateral or bilateral micro-TESE was guided by the intra-operative evaluation of sperm recovery from the first testicle. A unilateral procedure was performed in 87.5% (21/24) and 57% (4/7) of the micro-TESE and TESA cohorts, respectively. Sperm recovery was successful in 96% (23/24) of the men who underwent micro-TESE and 43% (3/7) of the men who underwent TESA (p < 0.01). The ICSI pregnancy rates (per embryo transfer) in the micro-TESE and TESA groups were comparable [33% (6/18) and 50% (1/2), respectively]. The data indicate that micro-TESE is a highly successful sperm retrieval technique for men with cryptozoospermia and few of these men will require a bilateral procedure. Moreover, sperm retrieval rates are higher with micro-TESE than TESA in this group of men.

Intracytoplasmic Sperm Injection Outcomes with Freshly Ejaculated Sperms and Testicular or Epididymal Sperm Extraction in Patients with Idiopathic Cryptozoospermia

“…Nagy et al (1995) and Aboulghar et al (1997) reported that the fertilization and pregnancy rates by testicular spermatozoa were significantly lower than those of ejaculated and epididymal spermatozoa in non-obstructive azoospermia (10, 15). The sperm extraction proportion from testicular and epididymis in our study was similar but fertility outcomes in PESA sub-group was significantly better than outcomes of TESE sub-group, similar to the results of Alrabeeah et al (16). In contrast to our study results, Some researchers believe that the fertilization rate of testicular extracted spermatozoa from non-obstructive azoospermic men is comparable to ejaculated spermatozoa in men with unexplained fertility and also stated that the fertilization rate of severe oligospermia or cryptozoospermia is similar to that of testicular spermatozoa source (15, 18, 19).…”

“…In order to avoid the cancellation of ICSI in these cases, most infertility centers provide an alternative surgically sperm extraction (PESA or TESE) (10) synchronous to oocyte retrieval (16); however, there is a debate about outcomes of ejaculated sperm and extracted sperm in literature. Therefore, we conducted a prospective cohort study to highlight outcome differences in these two methods of sperm retrieval.…”

Mini‐incision microdissection testicular sperm extraction: a useful technique for men with cryptozoospermia

“…In the case of a successful mini‐incision micro‐TESE, 2–5 additional biopsies are harvested from the superficial tissue to ensure that sufficient numbers of spermatozoa will be available for ICSI. We established that the intra‐operative identification of ≥5 spermatozoa was a minimum number based on our recent observations (Alrabeeah et al ., ). We sub‐categorized the micro‐TESE procedures into two groups (1‐mini‐incision micro‐TESE and 2‐standard unilateral or bilateral microTESE) based on the extent of testicular dissection.…”

“…As part of the procedure, most centers perform an immediate (intra‐operative) microscopic assessment of the extracted testicular tissue. This will help guide the surgeon on the need to continue extracting tissue in the ipsilateral and/or contra‐lateral testis or terminate the procedure (Tsujimura et al ., ; Turunc et al ., ; Ramasamy et al ., , ; Alrabeeah et al ., ).…”

“…We developed a modification of the micro‐TESE technique involving a mini tunica albuginia incision (mini‐incision) based on our recent observations in men with NOA and cryptozoospermia (Alrabeeah et al ., ,b). We noted that in these men, the rapid identification of spermatozoa was often possible (Alrabeeah et al ., ). As such, the aim of our study was to examine the success rate and potential feasibility of a mini‐incision micro‐TESE in men with NOA and cryptozoospermia.…”