William J. Huang, Shen Huang, Tzu-Chun Wei
Objective: Micro-dissection testicular sperm extraction (mTESE) nowadays has been the major sperm retrieval method for patients with non-obstructive azoospermia (NOA) in assisted reproduction technology (ART). However, there are still 40% to 50% chances that no sperm can be found after the procedure, and the ICSI cycles are then aborted. Therefore the couples need to take the significant physical, psychological and financial risks, including ovulation induction, eggs retrieval and costs for procedures. We introduce the concept of diagnostic mTESE for men with NOA to determine the decision to initiate ovulation cycles.
Methods: From 2012 to 2014, 152 men received diagnostic mTESE procedures. This study had excluded patients with obstructive azoospermia and needle biopsy-confirmed hypospermatogenesis cases. Patients with undescended testis, Klinefelter’s syndrome, or Y microdeletion were included. The procedure was performed by Schlegel’s method, the testicular tissues were examined under operative microscope up to 24 X. The procedures were started from right testicle, if no sperm found from right side, then left side was opened consequently. The tubules larger than 300 μm were sampled for immediate table side touch print smear examination and the tissues were transferred to Bouin’s fixatives for further pathological examination. The whole procedure was video-taped for future review. The location of sperm-positive areas was recorded in operation note. The testis wound at tunica albuginea was closed using intra-tunical zipper suture with 6-0 Prolene.
Results: Among the 152 patients, the mean sperm retrieval rate was 45.3%. If we included the patients with biopsy-confirmed hypospermatogenesis receiving only therapeutic mTESE, the overall sperm retrieval rate was about 61%. For the patients with positive results at diagnostic mTESE, the sperm retrieval rate at later therapeutic mTESE for ICSI cycle was 100%. For patients who had no sperm found at diagnostic mTESE, they were advised for other options including using donor sperm or adoption.
Conclusions: Through this management protocol, up to 55% of infertile couple might avoid the unnecessary ovulation cycle, egg retrieval and the related risks and expenses. The only disadvantage was the necessity for repeat mTESE procedure for infertile men although the subsequent mTESE was significantly time saving, focus-oriented and strait forward.
