Evaluating a gentler sperm extraction surgery

This study looked at mini-incision micro-dissection testicular sperm extraction, a modified surgery to collect sperm. It found that this was a useful procedure for men who do not produce enough sperm and that it may be less invasive than other surgeries.

Non-obstructive azoospermia (NOA) is a condition in which a man produces very few sperm. Around 10% of men with infertility have NOA. Cryptozoospermia (CZS) is a related condition in which sperm are difficult to collect from a semen sample.

Intracytoplasmic sperm injection (ISCI) is a treatment option for NOA. ISCI is a variation of the infertility treatment in vitro fertilization (IVF). During ISCI, a single sperm is injected into an egg, which allows fertilization when few sperm are available. However, it is still necessary to collect sperm.

Testicular sperm extraction (TESE) uses surgery to collect sperm directly from the testes. Micro-dissection TESE (micro-TESE) uses a microscope to guide the surgery. This concentrates biopsies (removed samples) on areas with the most sperm and avoids blood vessels, which reduces scarring and inflammation.

A modified procedure, mini-incision micro-TESE (mini-micro-TESE) has been developed. This procedure creates an incision in a different area of the testes. This allows the incision to be smaller. If sperm are not collected during the mini-micro-TESE, the incision can be lengthened into a more extensive micro-TESE. It is unclear whether mini-micro-TESE is an effective alternative surgery.

This study used records from 103 patients who underwent micro-TESE. 74 patients had NOA and 29 had CZS. The surgery was done the day before a planned ISCI. The surgery was considered successful if at least 5 sperm were collected.

The initial mini-incision procedure was successful for 25.6% of men with NOA and 58% of men with CZS. When the mini-incision procedure was successful, significantly fewer biopsies were needed (8.8 vs. 24.3).

For patients for which 5 sperm were not collected, the incision was extended. The extended micro-TESE was successful for 30% of the patients with NOA. It was a success for 75% of patients with CZS.

Overall, 48% of patients with NOA and 89% of patients with CZS had a successful sperm retrieval.

This study found that mini-incision micro-TESE is a useful technique to collect sperm from men with NOA and CZS.

The embryologist informed the surgeons in real-time whether sperm had been collected, from a lab next to the operating room. Not all fertility clinics are able to replicate this procedure.