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Clinical Trial
. 2016 May 12;16(1):20.
doi: 10.1186/s12894-016-0138-6.

A novel stepwise micro-TESE approach in non obstructive azoospermia

Giorgio Franco  1 , Filomena Scarselli  2 , Valentina Casciani  2 , Cosimo De Nunzio  3 , Donato Dente  4 , Costantino Leonardo  5 , Pier Francesco Greco  2 , Alessia Greco  2 , Maria Giulia Minasi  2 , Ermanno Greco  2
Affiliations
Clinical Trial

A novel stepwise micro-TESE approach in non obstructive azoospermia

Giorgio Franco et al. BMC Urol. .

Abstract

Background: The purpose of the study was to investigate whether micro-TESE can improve sperm retrieval rate (SRR) compared to conventional single TESE biopsy on the same testicle or to contralateral multiple TESE, by employing a novel stepwise micro-TESE approach in a population of poor prognosis patients with non-obstructive azoospermia (NOA).

Methods: Sixty-four poor prognosis NOA men undergoing surgical testicular sperm retrieval for ICSI, from March 2007 to April 2013, were included in this study. Patients inclusion criteria were a) previous unsuccessful TESE, b) unfavorable histology (SCOS, MA, sclerahyalinosis), c) Klinefelter syndrome. We employed a stepwise micro-TESE consisting three-steps: 1) single conventional TESE biopsy; 2) micro-TESE on the same testis; 3) contralateral multiple TESE.

Results: SRR was 28.1 % (18/64). Sperm was obtained in both the initial single conventional TESE and in the following micro-TESE. The positive or negative sperm retrieval was further confirmed by a contralateral multiple TESE, when performed. No significant pre-operative predictors of sperm retrieval, including patients' age, previous negative TESE or serological markers (LH, FSH, inhibin B), were observed at univariate or multivariate analysis. Micro-TESE (step 2) did not improve sperm retrieval as compared to single TESE biopsy on the same testicle (step 1) or multiple contralateral TESE (step 3).

Conclusions: Stepwise micro-TESE could represent an optimal approach for sperm retrieval in NOA men. In our view, it should be offered to NOA patients in order to gradually increase surgical invasiveness, when necessary. Stepwise micro-TESE might also reduce the costs, time and efforts involved in surgery.

Keywords: Azoospermia; ICSI; Micro-TESE; Sperm retrieval; TESE.

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Figures

Fig. 1
Fig. 1
Stepwise microTESE; a Conventional single TESE: the dotted line indicates the extension of the original incision in order to perform micro-TESE; b micro-TESE; c contralateral conventional multiple TESE
See this image and copyright information in PMC

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References

    1. Dabaja AA, Schlegel PN. Microdissection testicular sperm extraction: an update. Asian J Androl. 2013;15:35–9. doi: 10.1038/aja.2012.141. - DOI - PMC - PubMed
    1. Oliveira Filho AB, Souza RS, Azeredo-Oliveira MT, Peruquetti RL, Cedenho AP. Microdissection testicular sperm extraction causes spermatogenic alterations in the contralateral testis. Genet Mol Res. 2010;9:1405–13. doi: 10.4238/vol9-3gmr860. - DOI - PubMed
    1. Glina S, Soares JB, Antunes N, Jr, Galuppo AG, Paz LB, Wonchockier R. Testicular histopathological diagnosis as a predictive factor for retrieving spermatozoa for ICSI in non-obstructive azoospermic patients. Int Braz J Urol. 2005;31:338–41. - PubMed
    1. Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to intracytoplsmic sperm injecyion (ICSI) for azoospermia. Cochrane Database Syst Rev. 2008;(2):CD002807. - PMC - PubMed
    1. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14:131–5. doi: 10.1093/humrep/14.1.131. - DOI - PubMed

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