Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue
Ryan K Flannigan1, Peter N Schlegel2
1Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Weill Cornell Medicine, Department of Urology, New York, New York.
Fertility and Sterility
|March 5, 2019
Summary
Microdissection testicular sperm extraction (mTESE) is effective for nonobstructive azoospermia infertility. Optimizing patients before mTESE and specific tissue processing techniques improve sperm retrieval and pregnancy success rates.
Area of Science:
- Reproductive Medicine and Urology
- Sperm Retrieval Techniques
- Infertility Treatment
Background:
- Nonobstructive azoospermia is a significant cause of male infertility.
- Testicular sperm extraction (TESE) and in vitro fertilization (IVF) offer treatment options.
- Microdissection TESE (mTESE) is considered the optimal sperm retrieval method.
Purpose of the Study:
- To systematically review and evaluate literature on patient optimization before mTESE.
- To assess mTESE techniques and post-procedure testicular tissue processing.
- To identify strategies for improving sperm retrieval and IVF outcomes in nonobstructive azoospermia.
Main Methods:
- Systematic literature review of studies on mTESE.
- Evaluation of preoperative optimization strategies, including hormone therapy and varicocele repair.
- Analysis of testicular tissue processing methods post-mTESE.
Main Results:
- Limited data exist for adjuvant medical therapy, but varicocele repair shows promise for increased sperm retrieval, pregnancy, and ejaculate sperm return.
- Few comparative studies on post-mTESE tissue processing exist.
- Combined mechanical mincing and type 4 collagenase with pentoxifylline appear effective for identifying viable spermatozoa.
Conclusions:
- Patient optimization, particularly varicocele repair, may enhance mTESE outcomes.
- Specific testicular tissue processing methods, including enzymatic digestion and adjuncts like pentoxifylline, are crucial for sperm identification.
- Further research is needed to optimize mTESE protocols and tissue processing for nonobstructive azoospermia.
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