Abstract
BackgroundThe aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T).MethodsWe operated on 48 men (35 +/- 8 years) with non-obstructive azoospermia (NOA). If no spermatozoa were found following a micro epididymal sperm extraction (Silber et al., 1994) and testicular biopsy, testicular microdissection was performed or multiple microsurgical testicular biopsies were taken. The mean follow-up of the serum T was 2.4 +/- 1.1 years.ResultsSperm was retrieved in 17/48 (35%) of the men. The per couple take home baby rate if sperm was retrieved was 4/17 (24%). Serum T decreased significantly at follow-up (p < 0.05) and 5/31 (16%) de novo androgen deficiencies developedConclusionIn patients with non-obstructive azoospermia in whom no spermatozoa were found following a micro epididymal sperm aspiration and a simple testicular biopsy, we were able to retrieve spermatozoa in 35% of the men. The take home baby rate was 24% among couples with spermatozoa present upon TESE. De novo androgen deficiency occurred in 16% of the male patients following TESE indicating that, in men with NOA, long term hormonal follow up is recommended after TESE.
Highlights
The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T)
Study design We retrospectively evaluated the outcome of microsurgical TESE in patients with non-obstructive azoospermia (NOA) treated at the Ghent University Hospital, Belgium during the period January 1999 to June 2001
Complications of surgical procedures Mild pain lasting 3–14 days was reported by all patients, while 2 patients complained of more severe pain lasting 1 month or more
Summary
The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T). Some authors have suggested a single large biopsy, others perform multiple smaller biopsies, and still others have reported excising a majority of the volume of the testis in an effort to sample enough tissue to extract spermatozoa from [10]. In 1999 Schlegel et al [12] reported on novel microsurgical techniques for TESE They used an operating microscope to identify regions containing spermatozoa in the testes of men with NOA and performed multiple biopsies while avoiding the subtunical blood vessels. Schlegel et al [12] achieved better retrieval rates using a microdissection technique (Microdissection TESE) while the amount of testicular tissue excised was reduced. In men where no spermatozoa were found in a non-microsurgical single testicular biopsy procedure, the retrieval rate was 35% [12]
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