Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue processing

Abstract

Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection. (Fertil Steril Ò 2019;111:420-6. Ó2019 by American Society for Reproductive Medicine.

Histology and sperm retrieval among men with Y chromosome microdeletions

“…Unfortunately, it is not clear if a repeat semen analysis with a more thorough evaluation of the centrifuged specimen prior to receiving recombinant FSH treatment would have also demonstrated rare sperm, as reported by Ron-El et al, given this study discovered occasional sperm cells after meticulous microscopic investigation amongst patients set for TESE (74). Studies on the effects of EMT on SRR among men with NOA who have failed prior sperm retrieval attempts is more extensive, though the results of the data are not clear, as these studies have not evaluated the relative effects of repeat sperm retrieval alone vs. sperm retrieval repeat with EMT (97). According to this review of preoperative patient optimization for mTESE, adjuvant therapy prior to mTESE for men with YCM and NOA may be used but insufficient data exists to determine if a positive effect on spermatogenesis occurs.…”

Extended indications for varicocelectomy

“…In fact, some reports have found that up to 35% of men with NOA may transiently have sperm in their semen analysis without any sort of treatment 22 . Additionally, around 25% of men who regain sperm in their ejaculate following varicocelectomy regress to azoospermia on subsequent semen analyses 23– 25 . Furthermore, Schlegel and Kaufmann published a study in which, although 22% of men with NOA gained sperm in their ejaculate after varix ligation, only 9.6% of the patients had sufficient motile sperm so as to avoid testicular sperm extraction 26 .…”

Conventional TESE technique: A short review and a single-centre experience in 9 years

“…mTESE procedure Microsurgical testicular sperm extraction (mTESE) was first described by Schlegel in 1999 6 as an advanced microsurgical treatment assisted with operating microscope for retrieving sperm from men with NOA. 7 Some recent studies suggests that mTESE is 1.5-fold better at sperm extraction than conventional TESE when harvesting random multiple biopsies at three different parts of the testis. It is also twice as effective as testicular aspiration (TESA) in controlled trials.…”