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Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative
K Alrabeeah1, R Doucet2, E Boulet2
1Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
Abstract:
The minimum sperm count and quality that must be identified during microdissection testicular sperm extraction (micro-TESE) to deem the procedure successful remains to be established. We conducted a retrospective study of 81 consecutive men with non-obstructive azoospermia who underwent a primary (first) micro-TESE between March 2007 and October 2013. Final assessment of sperm recovery [reported on the day of (intracytoplasmic sperm injection) ICSI] was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a unilateral (with limited or complete microdissection) or bilateral micro-TESE was guided by the intra-operative identification of sperm recovery (≥5 motile or non-motile sperm) from the first testicle. Overall, sperm recovery was successful in 56% (45/81) of the men. A unilateral micro-TESE was performed in 47% (38/81) of the men (based on intra-operative identification of sperm) and in 100% (38/38) of these men, spermatozoa was found on final assessment. In 42% (16/38) of the unilateral cases, a limited microdissection was performed (owing to the rapid intra-operative identification of sperm). The remaining 43 men underwent a bilateral micro-TESE and 16% (7/43) of these men had sperm identified on final assessment. The cumulative ICSI pregnancy rates (per cycle started and per embryo transfer) were 47% (21/45) and 60% (21/35), respectively, with a mean (±SD) of 1.9 ± 1.0 embryos transferred. The data demonstrate that intra-operative assessment of sperm recovery can correctly identify those men that require a unilateral micro-TESE. Moreover, the rapid identification of sperm recovery can allow some men to undergo a limited unilateral micro-TESE and avoid the need for complete testicular microdissection.
Insights
Intra-operative sperm identification during microdissection testicular sperm extraction (micro-TESE) accurately predicts success. This allows for unilateral procedures, potentially avoiding extensive bilateral dissection for better outcomes in non-obstructive azoospermia.
Area of Science:
- Reproductive Medicine
- Urology
- Andrology
Background:
- Microdissection testicular sperm extraction (micro-TESE) is a key procedure for non-obstructive azoospermia.
- Defining the minimum sperm recovery criteria for successful micro-TESE is crucial for patient management.
- Intra-operative assessment of sperm during micro-TESE requires further investigation to guide surgical decisions.
Purpose of the Study:
- To establish the minimum sperm count and quality for successful micro-TESE.
- To evaluate the efficacy of intra-operative sperm identification in guiding unilateral versus bilateral procedures.
- To determine the impact of intra-operative findings on final sperm recovery and subsequent intracytoplasmic sperm injection (ICSI) outcomes.
Main Methods:
- Retrospective analysis of 81 men with non-obstructive azoospermia undergoing primary micro-TESE.
- Sperm recovery assessed intra-operatively and at final analysis for ICSI.
- Surgical approach (unilateral/bilateral, limited/complete) determined by intra-operative sperm identification (≥5 motile or non-motile sperm).
Main Results:
- Overall sperm recovery success rate was 56% (45/81).
- Unilateral micro-TESE, based on intra-operative findings, resulted in 100% sperm recovery (38/38).
- Limited unilateral micro-TESE was feasible in 42% of unilateral cases, avoiding complete dissection.
Conclusions:
- Intra-operative sperm assessment reliably predicts successful sperm retrieval during micro-TESE.
- Identifying sperm intra-operatively allows for appropriate selection of unilateral micro-TESE.
- Rapid intra-operative sperm identification can enable limited unilateral procedures, potentially reducing surgical invasiveness.
