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Microdissection Testicular Sperm Extraction (Micro-TESE): Results of a Large Series from India

Ashraf CM, Dharmaraj P, Sankalp S, Sujatha R, MS Swati S, Vijayalakshmi D and Esteves SC

Objective: We describe our micro-TESE experience in a large group of men with Non-Obstructive Azoospermia (NOA) and poor prognosis for Sperm Retrieval (SR), and critically analyze the method´s results and limitations.

Methods: An ART facility was setup in a tertiary care center to perform SR using microsurgery. One hundred and eighty men with NOA underwent micro-TESE while their female partners received ovarian stimulation for Oocyte Pickup (OCP). Micro-TESE was performed on the day prior to OCP, and surgically-retrieved testicular sperm were used for sperm injections. We assessed sperm retrieval rates, operative aspects, and ICSI outcomes.

Results: The success of micro-TESE at obtaining testicular sperm for Intracytoplasmic Sperm Injection (ICSI) was 54.4% with no major complications. Sperm were obtained in 73.6 % of cases in which clearly dilated seminiferous tubules were seen, with minimal tissue excision which facilitated laboratory processing. Patients with successful and failed retrievals did not differ with respect to baseline characteristics, and presence of varicocele. Retrieval rates differed pertaining to testicular histology category. Also, retrieval rates were higher (53.1% vs. 35.6%) in patients who received medication to boost testosterone production prior to micro-TESE compared with those who did not. Sperm injections resulted in normal fertilization and embryo cleavage of 61% and 75%, respectively. A cumulative clinical pregnancy rate per ICSI cycle of 29.78 %, with an implantation rate of 19 %was achieved.

Conclusions: Micro-TESE is a valid method of SR in NOA. It yields sustainable results in poor prognosis azoospermic patients, with minimal damage to the testes. Our experience with micro-TESE applied to the most difficult cases of azoospermia is very reassuring, and we advocate that micro-TESE should be the method of choice in such cases.