PL 39. The current managements for non-obstructive zzoospermia

The fertility potential of patients with non-obstructive azoospermia (NOA) depends on sperm extraction from the tissue sample and then in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Testicular sperm extraction (TESE) from the limited sites of sperm production in the testes of men with NOA has been a primary challenge to the successful treatment of these patients.

1 Predictors for Successful Sperm Retrieval of NOA Patients

Combination of FSH level, Inhibin B level and testicular volume might be the predictors for the successful TESE.

2 Preparation of TESE

Genetic testing to identify the cause of low sperm production may provide important prognostic and diagnostic information for men with NOA. NOA patients may have very limited pockets of sperm production. This limited production should be optimized before undergoing an invasive procedure. Varicocele, hormone imbalance and other scrotal surgical procedure must be carefully considered before TESE procedure.

3 Treatment Approach and IVF/ICSI

Because it was found that only 33% of testicular samples from men with NOA will reliably survive freeze-thaw and have documentable viability, the TESE procedures should be carried during a programmed in vitro fertilization (IVF) cycle, to allow sperm to be used fresh after sperm extraction. Sperm retrieval is usually timed to occur on the day before oocyte retrieval. Testicular sperm often acquire at least twitching motility after they are retrieved and incubated overnight.

Approaches for sperm retrieval have included fine-needle aspiration, percutaneous testis biopsy, open testicular biopsy, multiple testicular biopsy (testicular sperm extraction), and micro-TESE. Micro-TESE allows identification of the seminiferous tubules that contain sperm, improving the yield of sperm retrieval and limiting the amount of testicular tissue that needs to be removed.