Updates on sperm retrieval techniques

Abstract

In the most extreme form of male infertility, the male partner is azoospermic. The advent of in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) has revolutionized our ability to treat azoospermia in both obstructive and non-obstructive cases. In obstructive azoospermia, it allows paternity without microsurgical reproductive tract reconstruction and also in cases where the reproductive tract is unreconstructable. In men with non-obstructive azoospermia, microdissection testicular sperm extraction (mTESE) has allowed us to retrieve sperm in men with exceedingly low sperm production. The introduction of microsurgery in sperm retrieval improves sperm yields and quality while minimizing the chance of surgical morbidity.

Keywords: Sperm retrieval; azoospermia; sperm; testis.

Figure 1

During mTESE, the testis is bivalved along the equatorial axis along an avascular plane. Once the initial wide exposure is performed and some sampling of superficial tissue shows no dilated seminiferous tubules, then “dissection lanes” (shown by dark vertical lines in the drawing) are made along avascular testicular lobules, allowing evaluation of every seminiferous tubule through the operating microscope. Only those seminiferous tubules showing dilation are removed for sperm extraction. mTESE, microdissection testicular sperm extraction.