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Peter N. Schlegel - One of the best experts on this subject based on the ideXlab platform.
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anti mullerian hormone level as a predictor of Sperm retrieval with microdissection Testicular Sperm Extraction in nonobstructive azooSpermia
Andrologia, 2021Co-Authors: Ahmad Aboukhshaba, Nahid Punjani, Sofia Doukakis, Peter N. SchlegelAbstract:Limited factors effectively predict Sperm retrieval with microdissection Testicular Sperm Extraction in men with nonobstructive azooSpermia. We therefore sought to evaluate the role of serum anti-Mullerian hormone as a predictive biomarker for successful Sperm retrieval. We included patients with pre-operative anti-Mullerian hormone levels and stratified them based on prior history of prior Sperm retrieval procedure. We compared hormone levels between those who did and did not have a successful Sperm retrieval and used receiver operating curves to determine an optimal cut-off value. A total of 46 men were included, of whom 18 (39.1%) had no prior Sperm retrieval and 11 (61.1%) had Sperm successfully retrieved. Pre-operative serum anti-Mullerian hormone levels were predictive of Sperm retrieval in patients with no prior attempts at retrieval (p = .03). Receiver operating curve for those without prior retrieval was 0.6753. The optimal anti-Mullerian hormone cut-off for those without prior Sperm retrieval was 0.133 ng/ml with a sensitivity of 0.91 and specificity of 0.29. Therefore, serum anti-Mullerian hormone levels have modest predictive value for Sperm retrieval in this cohort. The combination of clinical history, examination and laboratory investigations should continue to be used to guide surgeons in counselling patients regarding the chance of Sperm retrieval.
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two decades from the introduction of microdissection Testicular Sperm Extraction how this surgical technique has improved the management of noa
Journal of Clinical Medicine, 2021Co-Authors: Nahid Punjani, Caroline Kang, Peter N. SchlegelAbstract:The treatment of men with non-obstructive azooSpermia (NOA) has improved greatly over the past two decades. This is in part due to the discovery of in vitro fertilization (IVF) and intracytoplasmic Sperm injection (ICSI), but also significantly due to improvements in surgical Sperm retrieval methods, namely the development of microdissection Testicular Sperm Extraction (mTESE). This procedure has revolutionized the field by allowing for identification of favorable seminiferous tubules while simultaneously limiting the amount of Testicular tissue removed. Improving Sperm retrieval rates is imperative in this cohort of infertile men as there are a limited number of factors that are predictive of successful Sperm retrieval. Currently, Sperm retrieval in NOA men remains dependent on surgeon experience, preoperative patient optimization and teamwork with laboratory personnel. In this review, we discuss the evolution of surgical Sperm retrieval methods, review predictors of Sperm retrieval success, compare and contrast the data of conventional versus mTESE, share tips for optimizing Sperm retrieval outcomes, and discuss the future of Sperm retrieval in men with NOA.
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microdissection Testicular Sperm Extraction preoperative patient optimization surgical technique and tissue processing
Fertility and Sterility, 2019Co-Authors: Ryan Flannigan, Peter N. SchlegelAbstract:Infertility due to nonobstructive azooSpermia is treatable with the use of Testicular Sperm Extraction and IVF. The optimal approach for Sperm retrieval is microdissection Testicular Sperm Extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE Testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased Sperm retrieval, pregnancy, and return of Sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable Spermatozoa for intracytoplasmic Sperm injection.
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microdissection Testicular Sperm Extraction
Translational Andrology and Urology, 2017Co-Authors: Ryan Flannigan, Phil Bach, Peter N. SchlegelAbstract:Microdissection Testicular Sperm Extraction (microTESE) is considered the gold standard method for surgical Sperm retrieval among patients with non-obstructive azooSpermia (NOA). In this review, we will discuss the optimal evaluation of NOA patients and strategies to medically optimize NOA patients prior to microTESE. In addition, we will also discuss technical principles and pearls to maximize the chances of successful Sperm retrieval, Sperm retrieval rates (SRR) based upon Testicular histology, predictors of successful Sperm retrieval, gonadal recovery following microTESE, and potential complications.
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Predictive factors of successful microdissection Testicular Sperm Extraction
2016Co-Authors: Aaron M. Bernie, Ranjith Ramasamy, Peter N. SchlegelAbstract:AzooSpermia in men requires microsurgical reconstruction or a procedure for Sperm retrieval with assisted reproduction to allow fertility. While the chance of successful retrieval of Sperm in men with obstructive azooSpermia approaches>90%, the chances of Sperm retrieval in men with non-obstructive azooSpermia (NOA) are not as high. Conventional procedures such as fine needle aspiration of the testis, Testicular biopsy and Testicular Sperm Extraction are successful in 20–45% of men with NOA. With microdissection Testicular Sperm Extraction (micro-TESE), the chance of successful retrieval can be up to 60%. Despite this increased success, the ability to counsel patients preoperatively on their probability of successful Sperm retrieval has remained challenging. A combination of variables such as age, serum FSH and inhibin B levels, Testicular size, genetic analysis, history of Klinefelter syndrome, history of cryptorchidism or varicocele and histopathology on diagnostic biopsy have provided some insight into the chance of successful Sperm retrieval in men with NOA. The goal of this review was to evaluate the preoperative factors that are currently available to predict the outcome for success with micro-TESE
Ranjith Ramasamy - One of the best experts on this subject based on the ideXlab platform.
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using microscope for onco Testicular Sperm Extraction for bilateral testis tumors
Fertility and Sterility, 2018Co-Authors: Robert Carrasquillo, Luis Felipe Savio, Vivek Venkatramani, Dipen J Parekh, Ranjith RamasamyAbstract:Objective To demonstrate a step-by-step approach to the use of the operating microscope for onco-Testicular Sperm Extraction. Design Video presentation. Setting University hospital. Patient(s) A 34-year-old man (status post right orchiectomy at another institution for pT3 pure seminoma with negative preoperative tumor markers) was referred for contralateral orchiectomy for multifocal left testis mass and fertility preservation. A postoperative semen analysis for attempted cryopreservation of ejaculated semen identified azooSpermia. Intervention(s) Left radical orchiectomy, left microsurgical onco-Testicular Sperm Extraction (TESE). Main Outcome Measure(s) Intraoperative technique with commentary highlighting tips for successful fertility preservation via microsurgical onco-TESE. Discussion of alternatives. Result(s) This video provides a step-by-step guide to microsurgical onco-TESE coordinated with radical orchiectomy for testis cancer as a means of fertility preservation in an azooSpermic patient. Preoperative imaging with scrotal ultrasound can serve as a useful guide for targeting microdissection to areas of normal Testicular parenchyma for Extraction of seminiferous tubules likely to host normal Spermatogenesis. This patient had successful recovery and cryopreservation of abundant Testicular Sperm following targeted ex-vivo Testicular microdissection. Conclusion(s) Microsurgical onco-TESE may be offered to azooSpermic patients when undergoing orchiectomy for testis cancer. Use of preoperative imaging and the surgical microscope guide surgical dissection and optimize Sperm recovery.
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Predictive factors of successful microdissection Testicular Sperm Extraction
2016Co-Authors: Aaron M. Bernie, Ranjith Ramasamy, Peter N. SchlegelAbstract:AzooSpermia in men requires microsurgical reconstruction or a procedure for Sperm retrieval with assisted reproduction to allow fertility. While the chance of successful retrieval of Sperm in men with obstructive azooSpermia approaches>90%, the chances of Sperm retrieval in men with non-obstructive azooSpermia (NOA) are not as high. Conventional procedures such as fine needle aspiration of the testis, Testicular biopsy and Testicular Sperm Extraction are successful in 20–45% of men with NOA. With microdissection Testicular Sperm Extraction (micro-TESE), the chance of successful retrieval can be up to 60%. Despite this increased success, the ability to counsel patients preoperatively on their probability of successful Sperm retrieval has remained challenging. A combination of variables such as age, serum FSH and inhibin B levels, Testicular size, genetic analysis, history of Klinefelter syndrome, history of cryptorchidism or varicocele and histopathology on diagnostic biopsy have provided some insight into the chance of successful Sperm retrieval in men with NOA. The goal of this review was to evaluate the preoperative factors that are currently available to predict the outcome for success with micro-TESE
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outcomes of microdissection Testicular Sperm Extraction in men with nonobstructive azooSpermia due to maturation arrest
Fertility and Sterility, 2015Co-Authors: Aaron M. Bernie, Ranjith Ramasamy, Kalee Shah, Joshua A Halpern, Jason M Scovell, Brian D Robinson, Peter N. SchlegelAbstract:Objective To evaluate Sperm retrieval in men with nonobstructive azooSpermia and maturation arrest (MA) undergoing microdissection Testicular Sperm Extraction (micro-TESE). Design Retrospective chart review. Setting Tertiary referral center. Patient(s) Men with nonobstructive azooSpermia and MA who underwent micro-TESE. Intervention(s) Microdissection TESE. Main Outcome Measure(s) Sperm retrieval rate (SRR). Result(s) A total of 211 patients (13%) had a histologic finding of MA at the most advanced level. The overall SRR was 52%. A total of 146 patients were classified as having early MA (arrest at the primary Spermatocyte stage), and 65 as having late MA (early Spermatid stage). The SRR in men with early, vs. late, MA was 40% vs. 78%. Of the 211 men with MA, 51 had diffuse MA (100% of tubules showed MA). The SRR was significantly lower in men with diffuse vs. focal MA (35% vs. 57%). On multivariable analysis, late MA and higher follicle-stimulating hormone levels were positively associated with successful Sperm retrieval. Conclusion(s) Sperm were successfully identified in up to one half of the men with MA after micro-TESE. Among men with MA, late MA seems to be the best predictor of successful Sperm retrieval with micro-TESE.
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Comparison of microdissection Testicular Sperm Extraction, conventional Testicular Sperm Extraction, and Testicular Sperm aspiration for nonobstructive azooSpermia: a systematic review and meta-analysis
Fertility and sterility, 2015Co-Authors: Aaron M. Bernie, Douglas A. Mata, Ranjith Ramasamy, Peter N. SchlegelAbstract:Objective To investigate the relative differences in outcomes among microdissection Testicular Sperm Extraction (micro-TESE), conventional Testicular Sperm Extraction (cTESE), and Testicular Sperm aspiration (TESA) in men with nonobstructive azooSpermia. Design Systematic review and meta-analysis. Setting Outpatient academic and private urology clinics. Patients(s) Men with nonobstructive azooSpermia. Intervention(s) Micro-TESE, cTESE, or TESA. Main Outcome Measure(s) Sperm retrieval (SR). Result(s) Fifteen studies with a total of 1,890 patients were identified. The weighted average age of the patients was 34.4 years, the follicular stimulating hormone level was 20.5 mIU/mL, the T was 373 ng/dL, and the Testicular volume was 13.5 mL. In a direct comparison, performance of micro-TESE was 1.5 times more likely (95% confidence interval 1.4–1.6) to result in successful SR as compared with cTESE. Similarly, in a direct comparison, performance of cTESE was 2.0 times more likely (95% confidence interval 1.8–2.2) to result in successful SR as compared with TESA. Because of inconsistent reporting, evaluation of other procedural characteristics and pregnancy outcomes was not possible. Conclusion(s) Sperm retrieval was higher for micro-TESE compared with cTESE and for cTESE compared with TESA. Standardization of reported outcomes as well as combining all available SR data would help to further elucidate the SRs of these procedures.
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age does not adversely affect Sperm retrieval in men undergoing microdissection Testicular Sperm Extraction
Fertility and Sterility, 2014Co-Authors: Ranjith Ramasamy, Gianpiero D Palermo, Zev Rosenwaks, Jennifer Reifsnyder, Nikunj Trivedi, Peter N. SchlegelAbstract:Objective To evaluate the effect of male age on the outcome of microdissection Testicular Sperm Extraction (micro-TESE) and assisted reproductive technology. Design Clinical retrospective study. Setting Center for reproductive medicine at a tertiary university hospital. Patient(s) One thousand sixty-seven men with nonobstructive azooSpermia. Intervention(s) Micro-TESE, with intracytoplasmic Sperm injection when Sperm found. Main Outcome Measure(s) Sperm retrieval and clinical pregnancy. Result(s) Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men Conclusion(s) Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful Sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner
Armand Zini - One of the best experts on this subject based on the ideXlab platform.
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Testicular Sperm aspiration tesa or microdissection Testicular Sperm Extraction micro tese which approach is better in men with cryptozooSpermia and severe oligozooSpermia
Urology, 2021Co-Authors: Mohammad H Alkandari, Joseph Moryousef, Simon E V Phillips, Armand ZiniAbstract:Abstract Objectives To evaluate and compare Sperm retrieval outcomes by Testicular Sperm aspiration (TESA) and micro–dissection Testicular Sperm Extraction (micro-TESE) in non-azooSpermic men. Methods We conducted a retrospective study of 145 consecutive Testicular Sperm retrievals in men with cryptozooSpermia (n = 56) or severe oligozooSpermia (n = 84). The decision to perform a TESA or a micro-TESE was made after thorough discussion of the pros and cons of these procedures with the couple. Final assessment of Sperm recovery, on the day of ICSI, was reported either as successful (available Sperm for ICSI) or unsuccessful (no Sperm for ICSI). Results Mean Sperm concentration, Sperm motility, Testicular volume and serum FSH level of men undergoing TESA were not significantly different from those of men undergoing micro-TESE. In men with severe oligozooSpermia ( 0.05). In men with cryptozooSpermia, Sperm recovery was successful in 88% (42/48) of men who underwent micro-TESE and 25% (2/8) of men who underwent TESA (P Conclusions These data indicate that in men with severe oligozooSpermia, TESA and micro-TESE are equally successful Sperm retrieval techniques. However, in men with cryptozooSpermia, Sperm retrieval rates are significantly higher with micro-TESE than TESA.
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mini incision microdissection Testicular Sperm Extraction a useful technique for men with cryptozooSpermia
Journal of Andrology, 2016Co-Authors: Khalid Alrabeeah, J Witmer, S Ruiz, A H Almalki, Simon J Phillips, Armand ZiniAbstract:Microdissection Testicular Sperm Extraction (micro-TESE) was developed to minimize the Testicular injury associated with multiple open TESEs. We sought to evaluate a mini-incision micro-TESE in men with cryptozooSpermia and non-obstructive azooSpermia (NOA). We conducted a retrospective study of 26 consecutive men with NOA and cryptozooSpermia who underwent a primary (first) micro-TESE between March 2015 and August 2015. Final assessment of Sperm recovery (reported on the day of intra-cytoplasmic Sperm injection (ICSI)) was recorded as (i) successful (available Spermatozoa for ICSI) or (ii) unsuccessful (no Spermatozoa for ICSI). The decision to perform a mini-incision micro-TESE (with limited unilateral micro-dissection) or standard/extensive (with unilateral or bilateral micro-dissection) was guided by the intra-operative identification of Sperm recovery (≥5 Spermatozoa) from the first testicle. Overall, Sperm recovery was successful in 77% (20/26) of the men. In 37% of the men (8/26), the mini-incision micro-TESE was successful (positive Sperm recovery). The remaining 18 men required a standard (extensive) microdissection: 61% (11/18) underwent a unilateral and 39% (7/18) a bilateral micro-TESE. We found that 90% (9/10) of the men with cryptozooSpermia and 63% (10/16) of the men with NOA underwent a unilateral (mini or standard micro-TESE). The mini-incision micro-TESE allowed for successful Sperm recovery in 60% (6/10) of the men with cryptozooSpermia and 13% (2/16) of the men with NOA. The data demonstrate that a mini-incision micro-TESE together with rapid intra-operative assessment and identification of Spermatozoa recovery can be useful in men undergoing microTESE, particularly, men with cryptozooSpermia.
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Sperm retrieval outcomes with microdissection Testicular Sperm Extraction micro tese in men with cryptozooSpermia
Journal of Andrology, 2015Co-Authors: Khalid Alrabeeah, Simon J Phillips, A Wachter, B Cohen, Naif Alhathal, Armand ZiniAbstract:Summary Several studies support of the use of Testicular rather than ejaculated Spermatozoa for intracytoplasmic Sperm injection (ICSI) in couples with virtual azooSpermia or cryptozooSpermia, although this approach remains controversial. We sought to evaluate Sperm retrieval outcomes with microdissection Testicular Sperm Extraction (micro-TESE) in men with cryptozooSpermia. We conducted a retrospective study of 24 consecutive micro-TESEs in men with cryptozooSpermia. We also evaluated the outcomes of seven consecutive TESAs (Testicular Sperm aspiration) in cryptozooSpermic men during the same time period (January 2007 and September 2014). Micro-TESE and TESA were performed on the day prior to ICSI. Final assessment of Sperm recovery (reported on the day of ICSI) was recorded as (i) successful (available Spermatozoa for ICSI) or (ii) unsuccessful (no Spermatozoa for ICSI). The decision to perform a unilateral or bilateral micro-TESE was guided by the intra-operative evaluation of Sperm recovery from the first testicle. A unilateral procedure was performed in 87.5% (21/24) and 57% (4/7) of the micro-TESE and TESA cohorts, respectively. Sperm recovery was successful in 96% (23/24) of the men who underwent micro-TESE and 43% (3/7) of the men who underwent TESA (p < 0.01). The ICSI pregnancy rates (per embryo transfer) in the micro-TESE and TESA groups were comparable [33% (6/18) and 50% (1/2), respectively]. The data indicate that micro-TESE is a highly successful Sperm retrieval technique for men with cryptozooSpermia and few of these men will require a bilateral procedure. Moreover, Sperm retrieval rates are higher with micro-TESE than TESA in this group of men.
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can the rapid identification of mature Spermatozoa during microdissection Testicular Sperm Extraction guide operative planning
Journal of Andrology, 2015Co-Authors: Khalid Alrabeeah, Simon J Phillips, Naif Alhathal, R Doucet, E Boulet, Francois Bissonnette, Isaac Jacques Kadoch, Armand ZiniAbstract: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.
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is ex vivo microdissection Testicular Sperm Extraction indicated for infertile men undergoing radical orchiectomy for Testicular cancer case report and literature review
Fertility and Sterility, 2014Co-Authors: Nicholas Haddad, Khalid Alrabeeah, Ronald Onerheim, Armand ZiniAbstract:Objective To report a case of an infertile man with nonobstructive azooSpermia who underwent simultaneous radical orchiectomy for Testicular cancer and Testicular Sperm Extraction (TESE) for preservation of fertility. Design Case report and literature review. Setting University teaching hospital. Patient(s) A couple being treated for infertility. Intervention(s) Radical orchiectomy with simultaneous TESE. Main Outcome Measure(s) Sperm retrieval, histologic evaluation of archived Testicular pathology slides. Result(s) We retrieved 20 Spermatozoa from the multiple random TESE samples obtained at radical orchiectomy. Histologic evaluation of the archived Testicular pathology slides revealed that the testis contained several foci of active Spermatogenesis, suggesting that a significantly greater number of Spermatozoa would likely have been retrieved had a microdissection TESE been performed instead of the multiple TESEs. Conclusion(s) We propose that microdissection TESE should be considered the preferred Sperm retrieval technique at the time of radical orchiectomy in men with coexistent nonobstructive azooSpermia and Testicular cancer.
Akira Tsujimura - One of the best experts on this subject based on the ideXlab platform.
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morphologic and mitochondrial characterization of human Spermatogenic cells dispersed in wet preparation for Testicular Sperm Extraction establishment of a microscopic diagram of developing human Spermatogenic cells
Fertility and Sterility, 2011Co-Authors: Hidenobu Okuda, Akira Tsujimura, Tetsuya Takao, Yasushi Miyagawa, Keisuke Yamamoto, Shinichiro Fukuhara, Jiro Nakayama, Hiroshi Kiuchi, Norio Nonomura, Akihiko OkuyamaAbstract:The successful identification of Spermatozoa at microdissection Testicular Sperm Extraction is critical and can depend on the judgment of experienced reproductive clinicians. Therefore, we characterized human Spermatogenic cells based on stage-specific mitochondrial location and morphologic change by using a vital mitochondrion-specific fluorescent probe, Mitotracker, and stage-specific antibodies to make a useful microscopic diagram.
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androgen decline in patients with nonobstructive azoospemia after microdissection Testicular Sperm Extraction
Urology, 2008Co-Authors: Shingo Takada, Akira Tsujimura, Tetsuya Takao, Yasushi Miyagawa, Minoru Koga, Masami Takeyama, Tomohiro Ueda, Yasuhiro Matsuoka, Yoshio Okamoto, Kiyomi MatsumiyaAbstract:OBJECTIVES Microdissection Testicular Sperm Extraction (TESE) is the ideal procedure for obtaining a high Sperm retrieval rate. However, few studies of the postoperative endocrinologic course have been reported. We evaluated the endocrinologic course for 1 year after microdissection TESE and compared the results with the Testicular histologic findings. METHODS A total of 69 patients with nonobstructive azooSpermia who had undergone microdissection TESE were included. The overall Sperm retrieval rate was 50.7%. The endocrinologic data were evaluated before and 3, 6, and 12 months after surgery. RESULTS The mean serum total testosterone level in patients with hypoSpermatogenesis decreased postoperatively and had recovered by 12 months (102%). The mean serum total testosterone level in patients with Klinefelter syndrome also decreased postoperatively but had recovered to only 50% of the baseline value at 12 months after microdissection TESE. At 12 months, the mean serum total testosterone level in patients with maturation arrest was 93.1% of the preoperative level and that in patients with Sertoli cell-only syndrome was 80.6% of the preoperative level. The preoperative serum luteinizing hormone and follicle-stimulating hormone in patients with Klinefelter syndrome was high and remained high after microdissection TESE. The mean serum luteinizing hormone and follicle-stimulating hormone levels in patients with hypoSpermatogenesis did not change, and those in patients with maturation arrest increased continuously after microdissection TESE. Finally, those in patients with Sertoli cell-only syndrome increased up to 6 months after surgery and decreased after that. CONCLUSIONS The results of our study indicate that long-term endocrinologic follow-up is necessary after microdissection TESE, particularly for patients with Klinefelter syndrome to detect hypogonadism.
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microdissection Testicular Sperm Extraction prediction outcome and complications
International Journal of Urology, 2007Co-Authors: Akira TsujimuraAbstract:Testicular Spermatozoa can be retrieved successfully by the Testicular Sperm Extraction (TESE) procedure and used for intracytoplasmic Sperm injection in cases of non-obstructive azooSpermia (NOA). The successful application of TESE depends on the identification of seminiferous tubules containing Spermatozoa; Testicular tubules of patients with NOA are usually heterogeneous, and TESE may not always be successful in these patients. Microdissection TESE with an operative microscope is advantageous because larger, more opaque, and whitish tubules, presumably containing germ cells with active Spermatogenesis, can be identified directly. This procedure is currently the best method for the certain identification of Sperm, resulting in a high Spermatozoa retrieval rate and minimal postoperative complications. The present review considers the surgical procedure, outcome, prediction for Spermatozoa retrieval, and postoperative complications of microdissection TESE.
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clinical comparison of successful and failed microdissection Testicular Sperm Extraction in patients with nonmosaic klinefelter syndrome
Urology, 2007Co-Authors: Minoru Koga, Akira Tsujimura, Kiyomi Matsumiya, Tetsuya Takao, Yasushi Miyagawa, Masami Takeyama, Hideki Fujioka, Hiroshi Kiuchi, Shingo Takada, Yoshio OkamotoAbstract:OBJECTIVES Testicular Sperm Extraction (TESE), together with intracytoplasmic Sperm injection, has become the treatment of choice for patients with nonobstructive azooSpermia related to nonmosaic Klinefelter syndrome (KS) who want to father children. However, predicting successful microdissection TESE for patients with KS remains controversial. Thus, we conducted a study to determine whether the prediction of successful microdissection TESE is possible in patients with nonmosaic KS. METHODS The subjects were 26 men with nonmosaic KS who had undergone microdissection TESE. The patients were divided into two groups: those in whom the procedure was successful and those in whom it was not. Several factors, including patient age, Testicular volume, endocrinologic data, and intraoperative morphologic appearance of the testes were compared between the two groups. RESULTS Testicular Spermatozoa were retrieved successfully in 13 (50%) of the 26 patients. None of the factors investigated differed significantly between the two groups according to the Mann-Whitney U test or multivariate logistic regression analysis. Testicular Spermatozoa were successfully retrieved from 16 (94.1%) of the 17 testes in which the seminiferous tubules without sclerotic changes were observed but were not found in any of the 29 testes without seminiferous tubules (P <0.0001). CONCLUSIONS For patients with nonmosaic KS, it is encouraging that Testicular Sperm were successfully identified in 50% of our patients. Although we did not find any factor predictive of successful Testicular Sperm retrieval by microdissection TESE, the outcome of microdissection TESE for patients with nonmosaic KS appears to depend on the identification of seminiferous tubules without sclerotic changes in the Testicular tissue.
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prediction of successful outcome of microdissection Testicular Sperm Extraction in men with idiopathic nonobstructive azooSpermia
The Journal of Urology, 2004Co-Authors: Akira Tsujimura, Kiyomi Matsumiya, Tetsuya Takao, Yasushi Miyagawa, Minoru Koga, Masami Takeyama, Hideki Fujioka, Kazutoshi Fujita, Akihiko OkuyamaAbstract:ABSTRACT Purpose: Microsurgical techniques in Testicular Sperm Extraction can improve Sperm retrieval in patients with nonobstructive azooSpermia (NOA). However, Spermatozoa retrieval rates have still been reported to be around 50% for patients with NOA. Thus, a reliable prediction method for successful outcome is needed to avoid unnecessary surgery. In this retrospective study we determined the diagnostic and predictive values of noninvasive parameters used in the treatment of patients with NOA. Materials and Methods: We analyzed 9 preoperative factors including patient age, Testicular volume and endocrinological data of 100 patients with NOA using multivariate logistic modeling. Testicular Spermatozoa were retrieved successfully in 41 of the 100 patients (41%). Results: We found that the concentrations of follicle-stimulating hormone (FSH), total testosterone (TT) and inhibin B were considered the most influential preoperative factors. We developed a formula to calculate the probability of successful outcome, P=[1 + exp(5.201 − 0.048 × FSH − 0.449 × TT − 0.021 × inhibin B)] −1 . Association of predicted probabilities and observed responses was 0.77. A predicted probability of more than 15.7% was found to be the best cutoff. Sensitivity was 71.0% and specificity was 71.4% as determined by receiver operating characteristic analysis. Conclusions: We concluded that our formula should be useful for doctors considering microdissection Testicular Sperm Extraction for patients with NOA because our equation uses noninvasive parameters without a preoperative Testicular biopsy, which is a relatively invasive examination.
Gianpiero D Palermo - One of the best experts on this subject based on the ideXlab platform.
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microdissection Testicular Sperm Extraction in men with sertoli cell only Testicular histology
Fertility and Sterility, 2014Co-Authors: Boback Berookhim, Peter N. Schlegel, Gianpiero D Palermo, N Zaninovic, Zev RosenwaksAbstract:Objective To study the outcomes of microdissection Testicular Sperm Extraction (microTESE) among men with pure Sertoli cell–only histology on diagnostic Testicular biopsy. Design Retrospective cohort study. Setting Tertiary referral center. Patient(s) Six hundred forty patients with pure Sertoli cell–only histology on Testicular biopsy who underwent microTESE by a single surgeon. Intervention(s) MicroTESE. Main Outcome Measure(s) Sperm retrieval rates. Result(s) Overall, 44.5% of patients with Sertoli cell only had Sperm retrieved with microTESE. No difference was noted in Sperm retrieval rates based on testis volume (≥15 mL vs. Conclusion(s) Patients with previous Testicular biopsy demonstrating Sertoli cell–only histology can be counseled that they have a reasonable likelihood of Sperm retrieval with the contemporary delivery of microTESE. Given this finding, the utility of Testicular biopsy before microTESE is further questioned.
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age does not adversely affect Sperm retrieval in men undergoing microdissection Testicular Sperm Extraction
Fertility and Sterility, 2014Co-Authors: Ranjith Ramasamy, Gianpiero D Palermo, Zev Rosenwaks, Jennifer Reifsnyder, Nikunj Trivedi, Peter N. SchlegelAbstract:Objective To evaluate the effect of male age on the outcome of microdissection Testicular Sperm Extraction (micro-TESE) and assisted reproductive technology. Design Clinical retrospective study. Setting Center for reproductive medicine at a tertiary university hospital. Patient(s) One thousand sixty-seven men with nonobstructive azooSpermia. Intervention(s) Micro-TESE, with intracytoplasmic Sperm injection when Sperm found. Main Outcome Measure(s) Sperm retrieval and clinical pregnancy. Result(s) Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men Conclusion(s) Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful Sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner
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severe Testicular atrophy does not affect the success of microdissection Testicular Sperm Extraction
The Journal of Urology, 2014Co-Authors: Campbell Bryson, Ranjith Ramasamy, Gianpiero D Palermo, Zev Rosenwaks, Matthew Sheehan, Peter N. SchlegelAbstract:Purpose: Men with azooSpermia and severe Testicular atrophy may be counseled to avoid Sperm retrieval due to perceived limited success. We evaluated the outcomes of microdissection Testicular Sperm Extraction in men with severe Testicular atrophy (volume 2 ml or less).Materials and Methods: We reviewed the records of 1,127 men with nonobstructive azooSpermia who underwent microdissection Testicular Sperm Extraction followed by intracytoplasmic Sperm injection. They were classified into 3 groups based on average Testicular volume, including 2 ml or less, greater than 2 to less than 10 and 10 or greater. Sperm retrieval, clinical pregnancy and live birth rates were calculated. Clinical features evaluated included age, follicle-stimulating hormone level, cryptorchidism history, Klinefelter syndrome, varicocele and Testicular histology on diagnostic biopsy.Results: Testicular Sperm were successfully retrieved in 56% of the men. The Sperm retrieval rate in those with a Testicular volume of 2 ml or less, greate...
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overweight men with nonobstructive azooSpermia have worse pregnancy outcomes after microdissection Testicular Sperm Extraction
Fertility and Sterility, 2013Co-Authors: Ranjith Ramasamy, Gianpiero D Palermo, Jennifer Reifsnyder, Campbell Bryson, Q V Neri, Peter N. SchlegelAbstract:Objective To evaluate the effect of obesity on the outcome of Testicular Sperm Extraction (TESE) and assisted reproductive technology. Design Clinical retrospective study. Setting Center for reproductive medicine at a tertiary-care university hospital. Patient(s) Nine hundred seventy patients with nonobstructive azooSpermia. Intervention(s) Microdissection TESE followed by intracytoplasmic Sperm injection (ICSI). Main Outcome Measure(s) Sperm retrieval rate and clinical pregnancy rate. Result(s) Testicular Sperm were successfully retrieved in 55% of men overall. Of those with Sperm found, clinical pregnancy rate was 51% and live birth rate 40%. Sperm retrieval rates were similar in men with body mass index (BMI) 2 , 25–30 kg/m 2 , and >30 kg/m 2 (59%, 57%, and 54%, respectively). Mean BMI of men who contributed to pregnancy (27.3 ± 4.9 kg/m 2 ) was lower than for men whose Sperm did not contribute to a pregnancy (28.2 ± 5.4 kg/m 2 ). No man with BMI >43 kg/m 2 (n = 11) contributed to a successful pregnancy, even though Sperm were found in men with BMI up to 57 kg/m 2 . On multivariable logistic regression analysis, male BMI was the only predictor of successful pregnancy among the variables analyzed, including male age, female age, and female BMI. Conclusion(s) Overweight men have lower clinical pregnancy rate after microdissection TESE and ICSI compared with men with normal BMI. Men with BMI >43 kg/m 2 did not contribute to any pregnancies, despite successful Sperm retrieval.
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role of tissue digestion and extensive Sperm search after microdissection Testicular Sperm Extraction
Fertility and Sterility, 2011Co-Authors: Ranjith Ramasamy, N Zaninovic, Jennifer Reifsnyder, Campbell Bryson, Deborah Liotta, Carol Ann Cook, June Hariprashad, Dina Weiss, Q V Neri, Gianpiero D PalermoAbstract:Objective To report the chance of Sperm discovery in the laboratory when Sperm were not identified in the operating room (OR). Design Clinical retrospective study. Setting Department of urology at a tertiary university hospital. Patient(s) A total of 1,054 men with nonobstructive azooSpermia who underwent microdissection Testicular Sperm Extraction. Intervention(s) Preoperative and intraoperative parameters were analyzed relative to the chance of Sperm identification using a tissue digestion protocol in the laboratory if no Sperm were observed in the OR. Main Outcome Measure(s) Sperm retrieval, clinical pregnancy, and live birth rates. Result(s) Sperm were found in the OR in 52.5% of the 1,054 men. Of the 501 men for whom Sperm were not identified by andrologists in the OR, Sperm were found in the laboratory for an additional 35 (7%). On multivariable logistic regression analysis, the presence of germ cells intraoperatively was the only predictor of identifying Sperm in the laboratory after tissue digestion. Conclusion(s) In men undergoing microdissection Testicular Sperm Extraction, when Sperm were not observed in the OR despite extensive mechanical processing, Sperm were observed in the laboratory for 7% of the men. This information is valuable in counseling couples in the immediate postoperative period when no Sperm were identified intraoperatively.
