Abstract

The use of intracytoplasmic sperm injection (ICSI) has been a major breakthrough in the treatment of male infertility. Even patients with non-obstructive azoospermia (NOA) may benefit from the ICSI technique to father a child as long as spermatogenesis is present. There are several techniques to recover testicular sperm in patients with NOA. However, retrieval of spermatozoa is unfortunately still only successful in a subset of patients with NOA, and the most superior sperm retrieval method is still under debate. A more recent technique, microdissection testicular sperm extraction (MD-TESE) with an operative microscope collecting larger and more opaque seminiferous tubules, is a non-blind sperm retrieval technique with theoretical benefits. The MD-TESE procedure seems to be feasible, effective, and safe in NOA patients but also more technically demanding and time-consuming compared with conventional blind techniques. In the present report, we describe our clinical experience and results from our first 159 MD-TESE procedures. The probability to retrieve sperm with the MD-TESE technique is high in NOA cases where earlier sperm retrieval with blind methods such as needle aspiration, percutaneous needle biopsy, or conventional TESE has failed.

摘要

胞浆内精子注射（ICSI）的使用已成为治疗男性不育的重大突破。只要存在精子发生，即使是非阻塞性无精子症（NOA）的患者也可以从ICSI技术中受益，以育儿。有几种恢复NOA患者睾丸精子的技术。然而，不幸的是，精子的取回仍然仅在部分NOA患者中是成功的，最优越的精子取回方法仍在争论中。较新的技术是显微手术切除睾丸精子（MD-TESE），它是一种可手术的显微镜，用于收集更大，更不透明的生精小管，是一种具有理论价值的非盲精子提取技术。MD-TESE程序似乎可行，有效，与传统的盲法技术相比，它对NOA患者安全且安全，但技术要求更高且更耗时。在本报告中，我们描述了我们的前159种MD-TESE程序的临床经验和结果。在NOA情况下，使用盲注方法（如穿刺抽吸，经皮穿刺活检或常规TESE）进行较早的精子提取失败的NOA病例中，使用MD-TESE技术提取精子的可能性很高。