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 This technique is used in men with non obstructive azoospermia (NOA). NOA is usually characterised by small testis and raised FSH levels in the blood. It is interesting to note that about 50-60% of men with NOA will harbour small quantities of sperm in the testis although they may not ejaculate them.
The principle in sperm retrieval in NOA is too try and optimise the chances of finding sperm whilst reducing the risk of damage to a testis.
Historically, TESA or FNA was used to as a technique of sperm retrieval but it has now been superseded by micro TESE as the procedure of choice of extracting sperm in men with NOA. This technique is based upon that described by Schlegel in New York. Under a general anaesthetic an incision is made on the scrotum and both testes are delivered and each testis has an incision made transversely.
Under the microscope, any tubules containing sperm appear to be more dilated and opaque. It is these tubules, which are given to the embryologists at the time of the micro-dissection and sperm can be extracted from them.
Currently data seems to indicate that the micro-dissection sperm retrieval technique is the optimum technique in terms of sperm retrieval rates, and also reducing post-operative complications. More recently Mr Minhas has published his results for salvage mTESE in men who have had previous biopsies, with a sperm retrieval rate of almost 50% (see published outcomes).
Before any patients undergo micro-dissection sperm retrieval they will undergo full evaluation with genetic tests and hormone profile.
For more information, view our PDF.
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