Abstract
Introduction
Rare foci of sperm production may be found in up to 60% of men with nonobstructive azoospermia (NOA). Sperm production, if present, is minimal for sperm appearance in the ejaculate. Given that there are no treatment options to restore fertility, sperm retrieval is the only alternative to find testicular sperm than then can be used for in vitro fertilization (IVF). Among sperm acquisition methods, micro-TESE has higher success rates at obtaining sperm compared with testicular sperm extraction and testicular sperm aspiration.
Materials and Methods
This video describes the operative aspects of micro-TESE, performed on an outpatient basis, in a man with NOA and history of cryptorchidism in whom orchidopexy was performed at age 6. The concept of micro-TESE is to identify areas of sperm production within the testes with the aid of optical magnification (15-25X) and based on the size and appearance of the seminiferous tubules (ST).
Conclusion
Micro-TESE allowed the identification and extraction of sperm-containing STs with minimum tissue excision and marked reduction in time processing of testicular specimens for sperm injection.
EDITORIAL COMMENT
SCIMAGO INSTITUTIONS RANKINGSThe authors from Sao Paulo, Brazil elegantly demonstrate the operative aspects of micro-Testicular Sperm Extraction (TESE), performed on a man with nonobstructive azoospermia (NOA). In men with NOA, retrieval of spermatozoa offers an opportunity for fertility despite limited sperm production. This is performed with the aid of optical magnification (25X) and is processed in an in-vitro fertilization laboratory. Micro-TESE is successful at obtaining testicular sperm for intracytoplasmic sperm injection (ICSI). This video nicely portrays the surgical approach of micro-TESE and the importance of in-vitro fertilization in patients with NOA. While performing microdissection, one can identify seminiferous tubules with sperm and those with Sertoli cells only, which appear atretic. The difference between the larger and smaller tubules is not visible without optical magnification. The use of magnification and processing of the spermatozoa was accurately described by the authors. Since micro-TESE was described, microdissection has shown an improvement of sperm retrieval rate and decrease the amount of tissue excised (11. Schlegel PN: Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999; 14: 131-5.).
REFERENCES
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1Schlegel PN: Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999; 14: 131-5.
Publication Dates
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Publication in this collection
May/June 2013
History
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Received
10 Jan 2013 -
Accepted
27 Feb 2013
