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Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?
Author(s) -
Alrabeeah K.,
Doucet R.,
Boulet E.,
Phillips S.,
AlHathal N.,
Bissonnette F.,
Kadoch I. J.,
Zini A.
Publication year - 2015
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/andr.12018
Subject(s) - testicular sperm extraction , microdissection , sperm retrieval , sperm , intracytoplasmic sperm injection , azoospermia , andrology , semen , biology , medicine , embryo , pregnancy , in vitro fertilisation , infertility , biochemistry , genetics , gene , microbiology and biotechnology
Summary The minimum sperm count and quality that must be identified during microdissection testicular sperm extraction (micro‐ TESE ) to deem the procedure successful remains to be established. We conducted a retrospective study of 81 consecutive men with non‐obstructive azoospermia who underwent a primary (first) micro‐ TESE between March 2007 and October 2013. Final assessment of sperm recovery [reported on the day of (intracytoplasmic sperm injection) ICSI ] was recorded as (i) successful (available spermatozoa for ICSI ) or (ii) unsuccessful (no spermatozoa for ICSI ). The decision to perform a unilateral (with limited or complete microdissection) or bilateral micro‐ TESE was guided by the intra‐operative identification of sperm recovery (≥5 motile or non‐motile sperm) from the first testicle. Overall, sperm recovery was successful in 56% (45/81) of the men. A unilateral micro‐ TESE was performed in 47% (38/81) of the men (based on intra‐operative identification of sperm) and in 100% (38/38) of these men, spermatozoa was found on final assessment. In 42% (16/38) of the unilateral cases, a limited microdissection was performed (owing to the rapid intra‐operative identification of sperm). The remaining 43 men underwent a bilateral micro‐ TESE and 16% (7/43) of these men had sperm identified on final assessment. The cumulative ICSI pregnancy rates (per cycle started and per embryo transfer) were 47% (21/45) and 60% (21/35), respectively, with a mean (± SD ) of 1.9 ± 1.0 embryos transferred. The data demonstrate that intra‐operative assessment of sperm recovery can correctly identify those men that require a unilateral micro‐ TESE . Moreover, the rapid identification of sperm recovery can allow some men to undergo a limited unilateral micro‐ TESE and avoid the need for complete testicular microdissection.