The role of modern technologies in the management of azoospermia using microdissection TESE in the framework of the ECF-ICSI program. A literature review. Part I.

In the second part of the review, devoted to treatment of azoospermia by micro-TESE in program IVF/ICSI, there were considered issues of hormonal preparation of patients with non-obstructive azoospermia (NOA) prior to the course of GnRH, chorionic and menopausal gonadotropin treatment. Sperm retrieval efficiency increases after stimulation of spermatogenesis 6 months. Identification of additional factors such as FSH, AMH, and Inhibin B in blood serum and seminal plasma can provide more accurate prognosis of the outcome of micro-TESE. High level of FSH is not a contraindication for microsurgical sperm retrieval in men with NOA. Neither level of FSH nor testicular volume is related to the effectiveness of operation. Molecular genetic markers of residual spermatogenesis (ESX1, VASA and CLU genes) can serve as predictors of successful sperm retrieval during micro-TESE in patients with NOA. In the review there were also considered advantages of microdissection technique, technique of operation performance (including embryological stage of detection of spermatozoa in testicular tissue), and efficiency of micro-TESE depending on pathological patterns and complications after surgery.