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Are you afraid of testicular sperm extraction (TESE)?


Before starting the IVF program, the diagnostic microdissection testicular sperm extraction can improve the success rate of surgical sperm extraction on the oocyte retrieval day. It would be a great news in the couples with azoospermia.



Azoospermia is a severe male factor in the infertility, and the occurrence is around 15% in the infertile men. There are two types of azoospermia,—obstructive and non-obstructive. In the patients with the obstructive azoospermia, the testes are able to produce functional sperms (spermatozoa), but the duct is blocked. In the patients with the non-obstructive azoospermia, the testes are unable to produce functional sperms, and the original cause have not been identified yet in 76% of the patients. The fertility specialist generally recommended these patients to take microsurgical epididymal sperm aspiration (MESA; in the patients with obstructive azoospermia) or testicular sperm extraction (TESE; in the patients with non-obstructive azoospermia) combing with intracellular single sperm injection (ICSI) in the IVF program.

The microdissection testicular sperm extraction (micro-TESE) has the advantages avoiding the damage of testes blood supply or larger trauma. It makes a small incision (4~5cm) on the scrotum to take testes out. After cutting the tunica albuginea along the equatorial plane, the seminiferous tubule can be examined and then be biospied under the operating microscope. If the diameter of a particular seminiferous tubule is over 300μm, the sperm retrieval rate could be significantly increased.






According to the clinical experiences in the Taipei Veterans General Hospital (Taiwan), the aperture of gauze mesh could be used as a control. The sperm retrieval rate was improved if the diameter of seminiferous tubule is larger than the aperture of gauze mesh under microscope.

Seminiferous tubule diameter(μm)
>300
Sperm retrieval rate(%)
84

However, the micro-TESE may not work in 40-50% of the patients with non-obstructive azoospermia. It could happen that no extracted sperms can be used on the oocyte retrieval day, and the patients must cryopreserve their eggs instead.


Therefore, the diagnostic microdissection testicular sperm extraction (diagnostic mTESE) was developed. The diagnostic mTESE is doing the micro-TESE before the operation on the oocyte retrieval day. By conducting the Touch print smear (TPS), the biopsied sample can be stained to examine the existence of mature sperms with the freezing tissue-processing method. The site of found mature sperms would be recorded as references for the operation on the oocyte retrieval day.

During 2012 to 2014, 152 patients with non-obstructive azoospermia were recruited to evaluate the efficacy of the procedure. In the recruited cohort, the sperm retrieval rate with diagnostic mTESE was 45.3%, and then the rate on the oocyte retrieval day is almost 100%. It strongly proved that an advance diagnostic mTESE could improve the sperm retrieval rate on the oocyte retrieval day. It could prevent the unexpected egg-freezing in the IVF program, and also lessen the psychological stress in the patients.


References:
2015 Symposium, The Taiwanese Association of Andrology
Microdissection testicular sperm extraction:an update. Asian J Androl. 2013 Jan; 15(1): 35–39
Stork Fertility Center送子鳥 Stork Fertility Center送子鳥 Author