Male Infertility by Karthik Gunasekaran & N Pandiyan

Author:Karthik Gunasekaran & N Pandiyan
Language: eng
Format: epub
Publisher: Springer India, New Delhi

In a controlled study from our group involving 60 men with SF, we compared SRR between micro-TESE and conventional single-biopsy TESE (Verza Jr and Esteves 2011). The SRR was significantly higher with micro-TESE (45vs. 25 %; P = .005) both overall and after stratifying the patients by testicular histopathology phenotype (hypospermatogenesis, 93 vs. 64 %; maturation arrest, 64 vs. 9 %; Sertoli-cell-only syndrome, 20 vs. 6 %; P < .001). Controlled studies have corroborated our results showing that micro-TESE is associated with a higher sperm recovery and lower complication rates (below 5 %) than conventional TESE (Okada et al. 2002; Amer et al. 2000; Tsujimura 2007; El-Haggar et al. 2007). We have recently reported our updated experience involving 356 patients with SF who have undergone micro-TESE. SRR was 41.4 % overall (Esteves et al. 2014) and 100.0, 40.3, and 19.5 % according to the histopathology phenotypes of hypospermatogenesis, maturation arrest, and SCO, respectively (Esteves and Agarwal 2014). Micro-TESE has been shown to rescue approximately one third of the cases that failed in previous retrieval attempts with conventional TESE and TESA and is particularly useful for men with spermatogenic failure presenting the worst-case scenarios (Ashraf et al. 2013; Schlegel 1999). Lastly, a recent systematic review involving seven comparative studies and 1062 patients confirmed that micro-TESE in SF was associated with a more favorable sperm retrieval rate ranging from 42.9 to 63 % compared with 16.7 to 45 % in conventional TESE (Deruyver et al. 2014).

In conclusion, the efficiency of sperm retrieval in azoospermia due to SF varies according to the method of sperm acquisition. Micro-TESE should be the method of choice for SR in such cases because it not only increases the chance of retrieving testicular sperm for ICSI but also minimizes testicular damage (Table 7.1).

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