Management of azoospermia with special emphasis on microdissection testicular sperm extraction (mTESE) in non obstructive azoospermia prior to IVF/ICSI to optimize sperm retrieval rates, pregnancy, live birth rates–a systematic review

Abstract

Previously there was no option for infertility due to non obstructive azoospermia (NOA). But with advent of technology NOA has become treatable with the use of testicular sperm extraction and IVF. The most correct approach for sperm retrieval remains microdissection testicular sperm extraction (mTESE). This systematic review discusses and examines the literature in terms of Patient optimization before mTESE, Technique of mTESE, along with post mTESE testicular tissue processing. Preoperative patient medical therapy, data for varicocele repair support increased sperm retrieval, pregnancy and return of sperm in the ejaculate. Post mTESE tissue processing has few studies where comparison has been done, though most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline in assisting in identification of motile and viable spermatozoa for intractoplamic injection.