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Microdissection Testicular Sperm Extraction | Open Access Journals
Human Genetics & Embryology

Human Genetics & Embryology

ISSN: 2161-0436

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Microdissection Testicular Sperm Extraction

Azoospermia, defined as the absence of sperm in ejaculation after evaluation of the centrifuged semen on at least two occasions, is observed in approximately 1% of the population and in up to 15% of infertile men. Non-obstructive azoospermia (NOA), which is diagnosed in approximately 60% of azoospermic men, can be clinically detected in men with small-volume testes, elevated follicle-stimulating hormone (FSH), and, of course, azoospermia.1 Before From advances in intracytoplasmic sperm injection (ICSI) and microsurgery, options for this group of patients were limited to donor insemination. However, ICSI gave these men the opportunity to use in vitro fertilization (IVF) with sperm retrieved from their own testicles.2 Although men with NOA have different pathological patterns that can be treated with this approach, the technique of finding the Isolated areas of the sperm-producing testicle is critical to sperm retrieval and, ultimately, to the success of an IVF cycle. Multiple techniques for sperm retrieval have been described in the literature, including fine needle aspiration (FNA), percutaneous testicle biopsy, open testicular biopsy or testicular sperm extraction (TESE), and testicular sperm extraction by microdissection (micro-TESE). The main advantages of percutaneous FNA and testis biopsy techniques are their simplicity, low cost and minimal invasiveness. Conversely, it has been shown that a significantly lower sperm retrieval rate (SRR) was obtained when FNA was performed, compared to conventional TESE.3 In a conventional TESE procedure, a random incision (or incisions) is made in tunic and one variable Tissue volume is removed in an attempt to retrieve sperm.4 These multiple random tunic incisions or large tissue resection can lead to testicular devascularization and atrophy. Furthermore, postoperative intratesticular bleeding and scar formation lead to disruption of spermatogenesis and hormone production.

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