Abstract
The use of intracytoplasmic sperm injection (ICSI) has been a major breakthrough in the treatment of male infertility. Even patients with non-obstructive azoospermia (NOA) may benefit from the ICSI technique to father a child as long as spermatogenesis is present. There are several techniques to recover testicular sperm in patients with NOA. However, retrieval of spermatozoa is unfortunately still only successful in a subset of patients with NOA, and the most superior sperm retrieval method is still under debate. A more recent technique, microdissection testicular sperm extraction (MD-TESE) with an operative microscope collecting larger and more opaque seminiferous tubules, is a non-blind sperm retrieval technique with theoretical benefits. The MD-TESE procedure seems to be feasible, effective, and safe in NOA patients but also more technically demanding and time-consuming compared with conventional blind techniques. In the present report, we describe our clinical experience and results from our first 159 MD-TESE procedures. The probability to retrieve sperm with the MD-TESE technique is high in NOA cases where earlier sperm retrieval with blind methods such as needle aspiration, percutaneous needle biopsy, or conventional TESE has failed.
Highlights
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 revolutionized the treatment of male infertility [1]
Spermatozoa can be recovered for ICSI by percutaneous epididymal sperm aspiration (PESA) [3] or testicular sperm aspiration (TESA) [4,5]
There is evidence to suggest that microdissection testicular sperm extraction (MD-TESE) may improve sperm retrieval in men with non-obstructive azoospermia (NOA), but goodquality randomized studies are still lacking
Summary
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 revolutionized the treatment of male infertility [1]. The most severe form of male infertility is non-obstructive azoospermia (NOA) where spermatogenesis is impaired or totally absent. Azoospermia is defined by the complete absence of spermatozoa in at least two semen analyses and is present in approximately 1% of adult men. If testicular spermatozoa can be retrieved, men with NOA can achieve biological fatherhood by means of ICSI [2]. The aetiology of azoospermia is divided into three groups: pre-testicular, testicular (non-obstructive), and post-testicular (Figure 1). Men with post-testicular (obstructive) azoospermia are usually normogonadotropic with normal spermatogenesis. Spermatozoa can be recovered for ICSI by percutaneous epididymal sperm aspiration (PESA) [3] or testicular sperm aspiration (TESA) [4,5]
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