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Case Reports
. 2021 Jan-Mar;22(1):65-69.
doi: 10.18502/jri.v22i1.4997.

Successful Targeted Testicular Sperm Extraction Using Microsurgical Technique (microTESE) Following Fine Needle Aspiration (FNA) Mapping in a Non-Obstructive Azoospermia (NOA) Patient: A Case Report

Ponco Birowo  1   2 , William Tendi  1   2 , Nur Rasyid  1 , Paul J Turek  3 , Ivan Rizal Sini  2 , Muhammad Rizal  2
Affiliations
Case Reports

Successful Targeted Testicular Sperm Extraction Using Microsurgical Technique (microTESE) Following Fine Needle Aspiration (FNA) Mapping in a Non-Obstructive Azoospermia (NOA) Patient: A Case Report

Ponco Birowo et al. J Reprod Infertil. 2021 Jan-Mar.

Abstract

Background: Management for male infertility can be difficult for some cases. Surgical intervention has long been thought as the last resort to help married couples to conceive. The current guideline recommends testicular sperm extraction with micro-surgery technique (microTESE) in severe cases of male infertility. However, the success rate still varies. Thus, a new strategy was needed to further increase the sperm retrieval success rate.

Case presentation: A 39-year-old male with a history of failed sperm extraction, non-obstructive azoospermia (NOA) and Y-chromosomal microdeletion came to the fertility center to undergo sperm retrieval. Fine needle aspiration (FNA) Mapping was performed prior to microTESE to increase the accuracy of sperm retrieval. After further examination with laser assisted immotile sperm selection (LAISS), five spermatozoa were found.

Conclusion: The combination of FNA Mapping and microTESE increases the chance of a successful sperm extraction.

Keywords: FNA Mapping; LAISS; NOA; Y-chromosomal microdeletion; microTESE.

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Conflict of interest statement

Conflict of Interest The authors declare that there is no conflict of interest in the production of this article.

Figures

Figure 1.
Figure 1.
Laser assisted immotile sperm selection (LAISS) procedure
Figure 2.
Figure 2.
Result of the patient’s fine needle aspiration mapping 3 months before microTESE
Figure 3.
Figure 3.
Ultrasound of left testis (Left) and right testis (Right)
Figure 4.
Figure 4.
Microdeletion of the patient (P=patient; N=normal; M=marker)
Figure 5.
Figure 5.
Timeline of the study
Figure 6.
Figure 6.
One spermatozoon was found onsite
Figure 7.
Figure 7.
A) Before LAISS procedure; B) After LAISS procedure; C) ICSI procedure. Note that the spermatozoon’s tail is curled after LAISS, indicating a viable state of spermatozoon
Figure 8.
Figure 8.
Testicular biopsy revealed few spermatids, along with spermatocytes
Figure 9.
Figure 9.
Systematic numbering of testes sampling site
See this image and copyright information in PMC

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