In vitro fertilization with intracytoplasmatic sperm injection in treatment of infertility in men with non-obstructive azoospermia: microdissection technique of sperm extraction from testicular tissue. Review of literature

Abstract

This article examines current methods of treatment of infertility in men with nonobstructive azoospermia (NOA). Prognostic factors for successful sperm retrieval using invasive procedures on the testicles are analyzed. Particular emphasis is put on the results of study of condition of AZF-region of Y-chromosome. This paper presents current classification of testicular biopsy material that describes various forms of abnormal spermatogenesis. The article deals issues of hormonal preparation in patients with NOA presurgical treatment with gonadotropin releasing hormone and chorionic and menopausal gonadotropin. Sperm retrieval efficiency increases in ≥ 6 months after use of spermatogenesis stimulation. Identification of additional hormonal factors such as follicle-stimulating hormone (FSH), anti-Mullerian hormone, inhibin B in serum and seminal plasma allows more accurate prediction of the outcome of microdissection testicular sperm extraction (microTESE) intervention. High FSH level is not a contraindication for microsurgical sperm retrieval in men with NOA. Neither FSH nor testicular volume is related to the effectiveness of the operation. Molecular genetic markers of residual spermatogenesis: genes ESX1, VASA, CLU may serve as predictors of successful sperm retrieval during microTESE in patients with NOA. This paper also describes advantages of microsurgical technique of operation, its effectiveness depending on pathological patterns and complications after surgery.