PD24-10 SINGLE CENTER OUTCOMES OF TESTICULAR SPERM ASPIRATION (TESA)

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 2014PD24-10 SINGLE CENTER OUTCOMES OF TESTICULAR SPERM ASPIRATION (TESA) Alexander Chow, Michelle Yu, Stephen Larsen, and Laurence Levine Alexander ChowAlexander Chow More articles by this author , Michelle YuMichelle Yu More articles by this author , Stephen LarsenStephen Larsen More articles by this author , and Laurence LevineLaurence Levine More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2001AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the last few decades, the demand for assisted reproductive techniques has greatly increased, particularly for the azoospermic man. Microscopic testicular sperm extraction (micro-TESE) has emerged as the favored approach for sperm retrieval. However, this procedure is invasive, usually requires general anesthesia, use of a microscope, has a significant economic burden, and in some, prolonged recovery. TESA was first offered in the 1990’s, with few recent outcome reports. Prior retrieval rates using TESA range from 10 – 49%. We evaluated our experience with TESA for men with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) for cryopreservation for fresh in-cycle use. METHODS The complete records of 161 men from 1999 – 2012 were reviewed for concentration of sperm per high power field, motility (%), forward progression (%) viability (%), and survival of a freeze-thaw cycle. All the sperm analysis post-extraction was completed at one fertility center. All procedures were performed under sedation and local anesthesia. Preoperative FSH and testosterone for all patients were obtained. RESULTS Of our 161 patients, 47 had OA while 115 had NOA. 1 patient had cystic fibrosis, 15 had known history of varicoceles, 7 had history of unilateral testicular cancer s/p orchiectomy, 1 had Conn’s syndrome, 4 had cryptorchidism, 10 with congenital bilateral absence of the vas deferens and 36 were post-vasectomy. Sperm was successfully obtained from at least one testicle if not bilaterally in 107 patients, a success rate of 66%. In 47 patients with OA, 46 patients had successful sperm aspiration yielding a 97.8% success rate, while in 61 out of 115 NOA patients viable sperm was aspirated with a success rate of 53.0%. In patients with NOA, 38 (33%) had elevated FSH levels with sperm successfully retrieved from only 7/38 patients (18%). While 9 OA patients had elevated FSH levels (19%) with 9/9 successful sperm retrieval. There were no postoperative adverse events, including hematoma, atrophy, new hypogonadism or hospital readmission. Return to daily activities was typically in 2 days. CONCLUSIONS TESA appears to offer a reasonably high likelihood of viable sperm retrieval in men with OA and NOA, which compares well with micro-TESE. The advantages of TESA include a quicker, less invasive, simpler, less costly alternative to micro-TESE, with a low-risk for side effects. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e734 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Chow More articles by this author Michelle Yu More articles by this author Stephen Larsen More articles by this author Laurence Levine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...