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Abstract

Volume 15, Issue 1 (January 2013) 15, 35–39; 10.1038/aja.2012.141

Microdissection testicular sperm extraction: an update

Ali A Dabaja and Peter N Schlegel

Department of Urology, Male Reproductive Medicine, Weill Cornell Medical College, New York, NY 10065, USA.

Correspondence: Professor PN Schlegel, (pnschleg@med.cornell.edu)

Received 5 October 2012; Revised 12 November 2012; Accepted 13 November 2012 Advance online publication 17 December 2012

Abstract

Patients with non-obstructive azoospermia (NOA) were once considered to be infertile with few treatment options due to the absence of sperm in the ejaculate. In the last two decades, the advent of intracytoplasmic sperm injection (ICSI), and the application of various testicular sperm retrieval techniques, including fine needle aspiration (FNA), conventional testicular sperm extraction (TESE) and microdissection testicular sperm extraction (micro-TESE) have revolutionized treatment in this group of men. Because most men with NOA will have isolated regions of spermatogenesis within the testis, studies have illustrated that sperm can be retrieved in most men with NOA, including Klinefelter's syndrome (KS), prior history of chemotherapy and cryptorchidism. Micro-TESE, when compared with conventional TESE has a higher sperm retrieval rate (SRR) with fewer postoperative complications and negative effects on testicular function. In this article, we will compare the efficacy of the different procedures of sperm extraction, discuss the medical treatment and the role of testosterone optimization in men with NOA and describe the micro-TESE surgical technique. Furthermore, we will update our overall experience to allow counseling on the prognosis of sperm retrieval for the specific subsets of NOA.

Keywords:

azoospermia; genetics; male infertility; microsurgery; non-obstructive azoospermia; sperm retrieval; testicular sperm extraction

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