Preoperative and intraoperative factors that predict difficult testicular sperm retrieval in patients with nonobstructive azoospermia

Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia

“…The mean tubule diameter measured under optical magnification was found to be 174. 4 Table 3). The total number of samples harvested was 1,661 (spermatozoa were identified in 662 out of 1,661 [39.8%] of the harvested samples).…”

“…Based on the fact that seminiferous tubules (ST), which contain germ cells, are larger and more dilated than tubules that are devoid of these germ cells, excision of the testicular tissue can be limited to the dilated ST areas with maximized yield of spermatozoa. Several studies have been published confirming Schlegel's (2) results reporting that optical magnification of testicular tissue increased sperm retrieval significantly in patients with NOA (3)(4)(5)(6)(7)(8). In 2004, Kamal et al were the first to report dissection and isolation of the most dilated tubule, after excision, using a stereoscope to maximize sperm retrieval.…”

Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia

“…In subjects suffering from obstructive azoospermia, the different microsurgical techniques are able to retrieve mature sperm from the different regions of the male reproductive tract [9]. In contrast, the retrieval of sperm may not always be successful in cases of non-obstructive azoospermia, as demonstrated by a number of retrospective studies reporting sperm recovery in a wide range of percentages [6][7][8][9][10].…”

“…ICSI and the modern techniques for sperm recovery from different regions of the male reproductive tract have led to the successful treatment of these patients. Therefore, testicular biopsy has become an important therapeutic procedure for testicular sperm recovery in non-obstruc-tive azoospermic patients, and testicular sperm extraction (TESE) is successful in 40 % -60 % of these patients [6][7][8][9][10]. Furthermore, sperm retrieved from the testes have been shown to be able to move and fertilize the oocyte [11][12][13].…”

“…To this aim several possible clinical and biochemical predictive factors, such as serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, testosterone and testicular volume, have been proposed, but to date none of these has been shown to be adequate [7,8,16].…”