(244) Optimization of Sperm Retrieval in Non-Obstructive Azoospermic Patients using Conventional TESE

Abstract

Abstract Introduction Sperm retrieval in NOA patients remain to be the only hope for these patients for fatherhood using assisted reproductive techniques. Micro-TESE is the gold standard with the best retrieval rate. Microsurgical facilities are not available at every center and conventional TESE techniques are not standardized between different centers. Objective Our aim is To improve the spermatogenic function of NOA patients to enable the appearance of sperm in their ejaculate or to improve the chances of a successful retrieval from the testis for ICSI and To optimize and standardize our conventional TESE technique Methods Over last 7 years 94 cases of NOA patients were subjected to conventional TESE. We Exclude the cases of Obstructive Azoospermia, Cases with abnormal chromosomal analysis were referred for higher center for genetic counselling and diagnosis. Laboratory workup including at least two semen samples, hormonal valuation (FSH, LH, Prolactin, Testosterone) and chromosomal analysis (Karyotyping and Testing for Y chromosome micro-deletions. Pre-TESE medical Treatment: included Clomiphene citrate: 50 mg OD for 3–6 months, Anti-oxidant therapy (Vitamin E 200mg BID and Vitamin C, 1 gm, OD). 6 biopsies from each testis: upper pole 2(medial &Lateral), mid zone 2 (medial & Lateral), lower pole 2(medial &Lateral). Separate biopsy from each testis was sent for definitive histopathological correlation. Experienced embryologist attends each procedure examining each biopsy until sperms are retrieved. Samples taken were centrifuged and re-examined at lab for any missed sperm Results sperm retrieval was successful in 38patients (40.4%). All cases were done as day case No single case of wound infection or intra-testicular hematoma.Post-operative pain was tolerable and managed by paracetamol ±NSAID Negative cases for sperms were continued on higher dose of CC and referred for microTESE Conclusions Though of low-evidence, empiric Pre-TESE enhancement of spermatogenesis should be attempted whenever possible and after proper patients counselling. This systematic anatomical approach for biopsies yielded high SRR compared to other conventional TESE. Exact localization of + ve testicular site and side If patient needed Re-do TESE for more sperms in the future. Although micro TESE remains to be the best modality for SR in NOA, in our hands and in canters without Micro-TESE facilities, applying this standardized technique with pre-operative hormonal manipulation yields accepted rate of sperm retrieval Disclosure No.