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Use of mini‐incision microdissection testicular sperm extraction in men with cryptozoospermia and non‐obstructive azoospermia
Author(s) -
Almajed Wael,
Alharbi Mohannad,
Zini Armand
Publication year - 2020
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.12795
Subject(s) - testicular sperm extraction , microdissection , medicine , azoospermia , sperm retrieval , sperm , surgery , dissection (medical) , intracytoplasmic sperm injection , infertility , andrology , biology , pregnancy , biochemistry , genetics , gene
Microdissection testicular sperm extraction (micro‐TESE) is a procedure commonly utilized to harvest spermatozoa in severe male factor infertility. We have developed a technique involving a mini tunica albuginea incision with superficial tissue dissection (mini‐incision micro‐TESE). The modification is designed to reduce potential tissue injury, and we studied its effectiveness to harvest spermatozoa in men with cryptozoospermia and non‐obstructive azoospermia. Materials and Methods We performed a retrospective analysis of 103 infertile men with NOA and cryptozoospermia who underwent a mini‐incision micro‐TESE between March 2015 and August 2018 at the OVO fertility clinic. We consider the mini‐incision micro‐TESE procedure successful when at least five spermatozoa are identified in the micro‐biopsies obtained from the superficial tissue exposed by the 1‐cm mini‐incision. If no spermatozoa are identified through the mini‐incision, we can easily extend the incision to the standard micro‐TESE. Results The mini‐incision procedure allowed for successful recovery of spermatozoa (intra‐operative recovery of ≥ 5 spermatozoa) in 58% of men with cryptozoospermia and 25.6% of men with NOA. Overall, a successful sperm retrieval (with conversion to conventional micro‐TESE if mini‐incision was not successful) was achieved in 89% of men with cryptozoospermia and 48% of men with NOA. A successful mini‐incision micro‐TESE was associated with a significantly lower number of biopsies than conventional micro‐TESE (8.8 vs 24.2, P < .0001). Moreover, in men undergoing a redo micro‐TESE after a previously successful micro‐TESE, 64% (9/14) had spermatozoa found and 21% (3/14) of these men only required a mini‐incision micro‐TESE. Conclusion Our data suggest that mini‐incision micro‐TESE is a useful approach in men undergoing micro‐TESE, allowing for a shorter incision and a high sperm retrieval rate in men with cryptozoospermia. Furthermore, the findings of our study offer insight into the distribution of spermatogenesis in men with cryptozoospermia and NOA.