Step-by-step loupes-mTESE in non-obstructive azoospermic men, a retrospective study

Area of Science:

• Reproductive Medicine
• Urology
• Andrology

Background:

• Non-obstructive azoospermia (NOA) necessitates sperm retrieval for male fertility.
• Conventional methods yield a 45% sperm retrieval rate (SRR).
• Microdissection testicular sperm extraction (mTESE) offers improved SRR (60%) by targeting dilated tubules.

Purpose of the Study:

• To evaluate a modified mTESE technique using magnifying loupes for sperm retrieval in NOA patients.
• To assess the efficacy and feasibility of this method in resource-limited settings.

Main Methods:

• A step-by-step macro-mTESE procedure was performed using 6-fold magnifying loupes.
• The study included 1050 patients with NOA from December 2003 to December 2017.
• Sperm retrieval was attempted on one or both testes, stopping if sperm was found in the first testis.

Main Results:

• Sperm was identified in the first testis in 61% of cases, minimizing testicular damage.
• The overall SRR increased from 43% to 51.8% compared to prior standard methods.
• The average operating time was 75 minutes for both testes.

Conclusions:

• Modified mTESE with magnifying loupes is a reliable and effective technique for sperm retrieval in NOA patients.
• This method is particularly beneficial in institutions lacking operating microscopes.
• It shows promise for patients with low testicular volumes and high FSH levels.