scholarly journals Performing Microdissection Testicular Sperm Extraction: Surgical Pearls from a High-Volume Infertility Center

2021 ◽  
Vol 10 (19) ◽  
pp. 4296
Author(s):  
Giovanni M. Colpi ◽  
Ettore Caroppo
Keyword(s):  
Clinical Practice ◽  
Gold Standard ◽  
High Volume ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
High Magnification ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Experienced Surgeon ◽  
Retrieval Rate

Microdissection testicular sperm extraction (mTESE) has been demonstrated to be the gold-standard surgical technique for retrieving testicular sperm in patients with non-obstructive azoospermia (NOA) as it enables the exploration of the whole testicular parenchyma at a high magnification, allowing the identification of the rare dilated seminipherous tubules that may contain sperm, usually surrounded by thinner or atrophic tubules. MTESE requires a skilled and experienced surgeon whose learning curve may greatly affect the sperm retrieval rate, as demonstrated in previous reports. The present review is intended to offer a precise and detailed description of the mTESE surgical procedure, accompanied by an extensive iconography, to provide urologists with valuable information to be translated into clinical practice. Advice about the pre-surgical and post-surgical management of patients is also offered.

scholarly journals Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia

2021 ◽  
Author(s):  
Pat Rohan ◽  
Niamh Daly ◽  
Aoife O’Kelly ◽  
Martin O’Leary ◽  
Tim Dineen ◽  
...  
Keyword(s):  
Gold Standard ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Optimal Cutoff ◽  
Randomized Controlled ◽  
Retrieval Rate ◽  
Continue Research ◽  
The Mean

Background: Microdissection testicular sperm extraction (mTESE) is the gold standard approach in sperm retrieval in men with non-obstructive azoospermia (NOA). The purpose of the study was to assess the outcomes for Irish men who have undergone mTESE with a single surgeon. Methods: This is a retrospective, single cohort study. Thirty-four patients underwent mTESE between September 2015 and June 2019. A p<0.05 was considered statistically significant. Results: In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10-5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle. Conclusion: The combination of mTESE/Intracytoplasmic sperm injection (ICSI) is the best option available for men with NOA who prefer to achieve paternity using their own DNA. Given the overall SRRs in mTESE, it is imperative to continue research for a predictive model to better counsel azoospermic men regarding the use of mTESE. For this purpose, large, multicenter, randomized controlled trials are needed.

Predictive Factors for Sperm Retrieval in Males With Non-obstructive Azoospermia

2021 ◽  
Author(s):  
Wei-Hsun Hsu ◽  
Marcelo Chen ◽  
Pai-Kai Chiang ◽  
Wei-Kung Tsai ◽  
Allen W Chiu ◽  
...  
Keyword(s):  
Sertoli Cell ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Testicular Volume ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Retrieval Rate ◽  
Normal Spermatogenesis

Abstract The aim of the current study was to investigate the predictive markers for males with non-obstructive azoospermia (NOA) before they received conventional testicular sperm extraction (cTESE) or microdissection testicular sperm extraction (microTESE). Between January 2010 and December 2020, a total of 56 patients who received cTESE or microTESE surgery at the Urology department of the MacKay Memorial Hospital were included. Our univariate analysis revealed that the following parameters was associated with sperm retrieval: Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testicular volume, histopathology of maturation arrest and Sertoli cell-only. The multivariate analysis showed that Sertoli cell-only was significantly less likely to harvest spermatozoa than normal spermatogenesis (OR = 0.03 (0.002-0.42); p = 0.01). A comparison of cTESE and microTESE revealed that the overall successful sperm retrieval rate was not significantly different between the two methods (74.1% vs. 58.6, p = 0.22). This study demonstrated that lower levels of FSH, LH and prolactin, and a higher testicular volume and better histopathology were associated with a higher sperm retrieval rate in the univariate analysis. In the multivariable analysis, only Sertoli cell-only syndrome appeared to have a significantly negative effect on the successful harvesting of sperm when compared with normal spermatogenesis.

scholarly journals Letrozole before TESE in Non-Obstructive Azoospermia, Does It Affect Sperm Retrieval Rate, A Retrospective Study

2020 ◽  
Vol 5 (1) ◽  
pp. p15
Author(s):  
Ghazi M. Al Edwan ◽  
Hammam H. Mansi ◽  
Ahmed Zuhier Al-Shalaby ◽  
Tareq Laith Al-Tell ◽  
Omar Nabeeh M. Atta ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Body Mass Index ◽  
The Other ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Inclusion Criteria ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Hormonal Profile ◽  
Retrieval Rate

Objective: This study was designed to evaluate the effect of letrozole 2.5 mg, an aromatase inhibitor, on the sperm retrieval rate (SRR) by the testicular sperm extraction (TESE) procedures that was done for the treatment of males with non-obstructive azoospermia (NOA).Materials and methods: Data was collected retrospectively from males diagnosed with non-obstructive azoospermia who underwent TESE procedure in the duration between May 2010 until June, 2018. The collected data includes the age of the patient, body mass index (BMI), testicular volume, hormonal profile (FSH LH, prolactin, testosterone), and the use of letrozole preoperatively. Logistic regression was done to address the association of these parameters to the sperm’s retrieval rate.Results: The study screaned 145 patients. Eighty patients fit the inclusion criteria and thus they were statistically analyzed. The use of letrozole was associated with negative TESE outcome (p=0.006), odd (0.154) CI 0.04-0.579. The other factors had no significant correlation to the TESE results.Conclusion: The evidence in this study showed an adverse effect of letrozole use on TESE results of those with high FSH.

scholarly journals Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: Long-term experience at a single institute

2018 ◽  
Vol 90 (2) ◽  
pp. 136 ◽  
Author(s):  
Cem Yücel ◽  
Salih Budak ◽  
Mehmet Zeynel Keskin ◽  
Erdem Kisa ◽  
Zafer Kozacioglu
Keyword(s):  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Retrieval Rate ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Long Term Experience

Objective: To observe the clinical practice of salvage microdissection testicular sperm extraction (mTESE) in patients with non-obstructive azoospermia (NOA) and to determine the factors that may predict the presence of spermatozoa in preoperative salvage mTESE. Methods: We retrospectively reviewed the medical records of 445 patients with the diagnosis of NOA, who had undergone the mTESE operation consecutively in our institution between the dates of March 2008 and June 2017. The study included a total of 49 patients with failure to detect spermatozoa in the first mTESE and who had then undergone salvage mTESE. In order to investigate the factors that predict the result of salvage mTESE, the patients were classified into two groups according to the outcome of salvage mTESE, as those with and without spermatozoa retrieval. Patients in these two groups were compared with regard to age, body mass index, history of varicocele, history of cryptorchidism, duration of infertility, outcomes of genetic analysis, results of hormone profiles and the testicular histopathology results of the first mTESE. Results: The sperm retrieval rate following salvage mTESE was observed to be 42.8%. Statistically a significant difference was determined between the mean follicle stimulating hormone (FSH) values of the groups (p = 0.013). No significant difference was observed between the groups with regard to the remaining parameters.Conclusion: It was observed that among the factors that predict the success of sperm retrieval in salvage mTESE in patients with NOA and previous unsuccessful sperm retrieval in mTESE operation, only the pre-operative FSH level was observed to significantly correlate with the success in salvage mTESE.

scholarly journals MICROSCOPIC TESTICULAR SPERM EXTRACTION

2018 ◽  
Vol 25 (02) ◽  
pp. 180-184
Author(s):  
Maher Saleh Moazin ◽  
Muhammad Tahir Bashir Malik ◽  
Muhammad Aslam ◽  
Naif Aldaham ◽  
Muhammad Yahya Alrawi
Keyword(s):  
Chromosomal Abnormalities ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Male Factor ◽  
Sperm Retrieval ◽  
Retrieval Rate ◽  
Medical City ◽  
Infertile Couples ◽  
Small Hematoma

Azoospermia, the complete absence of sperms in the ejaculate is found in 1% ofnormal males and 10-15% of infertile couples. Surgical sperm retrieval (SSR) and use of spermsfor ICSI/IVF offers an opportunity of parenting to the male factor infertile couples. Micro-TESEgives higher surgical sperms retrieval rates in those patients in whom the chances of spermretrieval otherwise are very low. Objectives: To evaluate the outcome of Microscopic TesticularSperm Extraction (Micro-TESE) in different patients groups of non-obstructive azoospermia,in terms of testicular volume, histopathology, hormones levels as well as cytogenetic variants.Study Design: Retrospectively reviewed. Setting: Urology Division, King Fahd Medical City,Riyadh in collaboration with King Abdullah Reproductive Medical Unit (RMU). Period: January2011 to January 2016. Material & Methods: Fifty-four patients of primary and secondary infertilityage range of 29 to 65 years who had undergone Microscopic Testicular Sperm Extraction(Micro-TESE). Outcome measures: Finding of sperm in testicular specimen extracted bymicroscopic testicular dissection. Results: Out of 54 patients, hormonal abnormalities werefound in 45% patients and 65% had low volume testes. Abnormal histology was found in 23%patients and 9% had chromosomal abnormalities. Overall sperm retrieval rate in all groups was33%. Sperm retrieval rate was 34 % in patients with small volume testes (<15ml), 42% patientswith abnormal hormones (FSH), 33% patients with abnormal histology and 38% in patientswith chromosomal abnormalities. Minor complications (small hematoma and orchalgia) wereobserved in two (3.7%) patients. Conclusion: Micro-TESE is a valid option for sperm retrieval inpatients in which probability of sperm retrieval is otherwise very low.

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