Abstract
Testicular sperm extraction (TESE) is a surgical procedure which, combined with intracytoplasmic sperm injection, constitutes the main treatment for achieving biological parenthood for patients with infertility due to non-obstructive azoospermia (NOA). Although it is effective, TESE procedures might cause structural testicular damage leading to Leydig cell dysfunction and, consequently, temporary or even permanent hypogonadism with long-term health consequences. To a lesser extent, the same complications have been reported for microdissection TESE, which is considered less invasive. The resulting hypogonadism is more profound and of longer duration in patients with Klinefelter syndrome compared with other NOA causes. Most studies on serum follicle-stimulating hormone and luteinizing hormone concentrations negatively correlate with total testosterone concentrations, which depends on the underlying histology. As hypogonadism is usually temporary, and a watchful waiting approach for about 12 months postoperative is suggested. In cases where replacement therapy with testosterone is indicated, temporary discontinuation of treatment may promote the expected recovery of testosterone secretion and revise the decision for long-term treatment.
Highlights
Testicular sperm extraction (TESE) is a surgical procedure which, in combination with intracytoplasmic sperm injection (ICSI), is currently used to enable men with nonobstructive azoospermia (NOA) to produce their biological children
The results depend on NOA causes and testicular histology, the latter being a heterogeneous entity with distinct pathological patterns, ranging from hypospermatogenesis to Sertoli cell-only syndrome (SCOS) [5,6,7,8]
A recent meta-analysis indicates that mTESE has a 1.5 times higher sperm retrieval rate (SRR) compared with conventional TESE (cTESE) and 2 times higher rate compared with testicular sperm aspiration (TESA)
Summary
Testicular sperm extraction (TESE) is a surgical procedure which, in combination with intracytoplasmic sperm injection (ICSI), is currently used to enable men with nonobstructive azoospermia (NOA) to produce their biological children. Several TESE techniques have been reported including simple or multi-biopsy conventional TESE (cTESE), microdissection TESE (micro-TESE, mTESE), and testicular sperm aspiration (TESA) [1]. Their development was imposed by the need for focused, less invasive, and more effective techniques for sperm retrieval, as spermatogenesis is focal in many patients with NOA [2]. A recent meta-analysis indicates that mTESE has a 1.5 times higher sperm retrieval rate (SRR) compared with cTESE and 2 times higher rate compared with TESA. MTESE should be preferred in men with NOA according to AUA/ASRM guidelines [9,10]
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