Dr. Vishal Dutt Gour,MBBS, MS, MCh (Urology)Director, SCI International HospitalM-4,GK-1,New Delhi-48

Micro-dissection Testicular Sperm Extraction (Micro-TESE)

Understand the difference between obstructive (OA)

and non-obstructive azoospermia (NOA)

Overview of sperm retrieval techniques for NOA (micro-TESE) and how to handle testicular sperm for

ICSI

Learn the success rates and prognostic factors of sperm retrieval in NOA using micro-TESE

Reproductive potential of Azoospermic men undergoing assisted conception

Learning Objectives

Azoospermia• It is not a synonymous of sterility

• Normal sperm production

• Mechanical blockage • Vasectomy, Post-infectious,

Congenital

Obstructive• Sperm production deficient or

absent

• Cryptorchidism, Orchitis, Radiation, Chemotherapy, Trauma, Genetic, Gonadotoxins, Idiopathic

Non-obstructive

INTRODUCTION

• Microsurgical Testicular Sperm Extraction or “Micro-TESE” has been developed to detect sperm in the testicles of men who have poor sperm production.

• Because the testicular tubules are microscopic structures, they cannot be distinguished by the naked eye.

• There is a higher chance that he will find sperm in “fuller,” more normal tubules than in scarred or fibrotic tubules.

Microscope- why a good one is required

• Always plan to follow gradual stepwise approach to retrieve sperm• Percutaneous Semineferous Biopsy 3 to 4 sites using 18/20 G

Scalp Vein• Deliver the testis and do a mapping to check• Proceed with Micro TESA

Approach

• Micro-TESE can be performed as a diagnostic procedure and if usable sperm are found, then they can be frozen and the couple is recommended to proceed with ICSI.

• It can also be performed and timed with an egg retrieval/IVF cycle so that the sperm are injected into the eggs without freezing.

• Freezing the sperm from men with sperm production problems can be difficult since these sperm are usually few in number and don’t thaw well.

• Therefore the best chance of pregnancy is to use fresh sperm obtained just prior to IVF.

• The chance of finding sperm with Micro-TESE is better than 60%. This is twice the chances of finding sperm by non-microsurgical or needle biopsies taken by general urologists. Micro-TESE is a great advance in male reproductive surgery, but is only performed by a small number of male reproductive surgeons.