Use of mini-incision microdissection testicular sperm extraction in men with cryptozoospermia and non-obstructive azoospermia

Abstract

Introduction: Microdissection testicular sperm extraction (micro-TESE) is a procedure commonly utilized to harvest spermatozoa in severe male factor infertility. We have developed a technique involving a mini tunica albuginea incision with superficial tissue dissection (mini-incision micro-TESE). The modification is designed to reduce potential tissue injury, and we studied its effectiveness to harvest spermatozoa in men with cryptozoospermia and non-obstructive azoospermia. Materials and Methods: We performed a retrospective analysis of 103 infertile men with NOA and cryptozoospermia who underwent a mini-incision micro-TESE between March 2015 and August 2018 at the OVO fertility clinic. We consider the mini-incision micro-TESE procedure successful when at least five spermatozoa are identified in the micro-biopsies obtained from the superficial tissue exposed by the 1-cm mini-incision. If no spermatozoa are identified through the mini-incision, we can easily extend the incision to the standard micro-TESE. Results: The mini-incision procedure allowed for successful recovery of spermatozoa (intra-operative recovery of ≥ 5 spermatozoa) in 58% of men with cryptozoospermia and 25.6% of men with NOA. Overall, a successful sperm retrieval (with conversion to conventional micro-TESE if mini-incision was not successful) was achieved in 89% of men with cryptozoospermia and 48% of men with NOA. A successful mini-incision micro-TESE was associated with a significantly lower number of biopsies than conventional micro-TESE (8.8 vs 24.2, P