ABSTRACT
To study the effectiveness of microsurgical testicular sperm extraction in non-obstructive azoospermia. Testicular sperm extraction [TESE] is well-defined procedure for surgical sperm retrieval in obstructive and non-obstructive azoospermia. This study was focused on the evaluation of the effectiveness of microsurgical testicular sperm extraction [TESE] in intracytoplasmic sperm injection [ICSI] for non-obstructive azoospermia. Material and Forty-two [42] male patients were included in this study. They were classified into 4 groups. Group I: Patients with normal sized tests and normal FSH, with previous diagnostic biopsy [10 patients]. Group II: Patients with normal sized tests and normal FSH, with previous conventional TESE [10 patients]. Group III: Patients with small sized tests and high FSH, and without previous testicular biopsy [20 patients]. Group IV: Patients with kleinfelter's syndrome [2 patients]. Microsurgical TESE was compared with conventional TESE as regard sperm recovery rate and complications were assessed by ultrasonographic and endocrinological methods. Microsurgical technique could extract sperm in 7 patients [70%] of group 1, 6 patients [60%] of group II and in in 5 patients [50%] of group III. It also succeded to extract sperm in group IV [kleinfelter's syndrome]. The sperm retrieval rate by microdissection TESE [60%] appeared higher than by conventional TESE [40%]. However, this observation failed to reach statistical significance. Microsurgical TESE could retrieve sperm in 100% of patients with hypospermatogenesis while conventional TESE retrieved sperm in 87.5%. Microsurgical TESE could retrieve sperm in 58.3% of patients with Sertoli only syndrome while conventional TESE retrieved sperm in only 8.3%. This was statistically significant [p < 0.05]. Microsurgical TESE could retrieve sperm in 20% of patients with maturation arrest while non-microsurgical TESE retrieved sperm in 40%. The complication rate was indifferent between microdissection and conventionol TESE. Microsurgical testicular sperm extraction is an ideal methodss for harvesting the sperm specially in difficult cases [small sized tests, cases of failed previous diagnostic biopsy or conventional TESE, repeated TESE, and in Kleinfelter's syndrome]. It allows selection of seminiferous tubules more likely to contain sperm specially in Sertoli only syndrome and Kleinfelter's syndrome. It also allows identification and avoidance of tessticular vessels, minimizing complications