Our Summary

This paper explains a method for retrieving sperm from men who are infertile due to a condition called nonobstructive azoospermia (NOA). NOA affects the testicles, resulting in extremely low or nonexistent sperm production. However, some patients may have small areas in their testicles that do produce sperm.

The researchers looked at a technique called micro-TESE (microdissection testicular sperm extraction). This is a surgical procedure that helps identify and retrieve sperm from the testicles of men with NOA. They reviewed studies on micro-TESE to understand how effective it is and if it leads to any complications.

They found 116 studies involving 4895 patients. On average, micro-TESE was able to find sperm in about 46.6% of men with NOA, but this rate varied quite a bit (from 18.4% to 70.8%). The variation largely depended on the specific traits of the patients.

The researchers also found that micro-TESE had a low complication rate (around 3%). When the retrieved sperm was used for a fertility treatment called ICSI (intracytoplasmic sperm injection), about 57% of the time it was successful in fertilizing an egg. And 39% of the time, it resulted in a pregnancy. The birth rate was 24%.

The health of the children born from this method seems good, but more research is needed. The researchers conclude that micro-TESE is a safe and effective way to retrieve sperm from men with NOA. It appears to be better than non-microsurgical methods, especially for men with a certain type of testicular issue. However, they also emphasize the need for more research, especially to compare different sperm retrieval methods and assess the long-term health of children born from this method.

FAQs

  1. What is micro-TESE and how does it help men with nonobstructive azoospermia (NOA)?
  2. What was the success rate of finding sperm in men with NOA using the micro-TESE method?
  3. What is the success rate of pregnancies and births when the retrieved sperm from micro-TESE is used for ICSI fertility treatment?

Doctor’s Tip

One helpful tip a doctor might tell a patient about testicular surgery, specifically micro-TESE, is to discuss the potential risks and benefits of the procedure. It is important for patients to understand that while micro-TESE can be an effective way to retrieve sperm for fertility treatment, there are potential complications that can occur. Patients should have a thorough discussion with their doctor about the procedure, including the success rates, potential complications, and any alternative options available. It is also important for patients to follow their doctor’s recommendations for post-operative care to ensure the best possible outcome.

Suitable For

Patients who are typically recommended testicular surgery, specifically micro-TESE, include men with nonobstructive azoospermia (NOA) who have extremely low or nonexistent sperm production. These patients may have small areas in their testicles that do produce sperm, making them candidates for micro-TESE to retrieve sperm for fertility treatments such as ICSI. It is important to note that the effectiveness of micro-TESE can vary depending on the specific traits of the patients, and more research is needed to compare different sperm retrieval methods and assess the long-term health of children born from this method.

Timeline

Before testicular surgery, a patient may experience infertility due to a condition like nonobstructive azoospermia (NOA). They may undergo tests to determine the cause of their infertility, including physical exams, semen analysis, hormone tests, and genetic testing. Once diagnosed with NOA, the patient may be recommended for micro-TESE surgery to retrieve sperm from the testicles.

After testicular surgery, the patient may experience some pain, swelling, and discomfort in the scrotum. They may need to take pain medication and rest for a few days. The retrieved sperm may be used for fertility treatments like ICSI to fertilize an egg and attempt to achieve pregnancy. The success rates of fertilization and pregnancy using sperm retrieved from micro-TESE are relatively high, but more research is needed on the long-term health outcomes of children born from this method. Overall, micro-TESE is considered a safe and effective way to retrieve sperm from men with NOA.

What to Ask Your Doctor

Some questions a patient should ask their doctor about testicular surgery, specifically micro-TESE for nonobstructive azoospermia, include:

  1. What is the success rate of micro-TESE in finding sperm in men with NOA?
  2. Are there any specific factors that may affect the likelihood of finding sperm during micro-TESE in my case?
  3. What are the potential complications or risks associated with micro-TESE?
  4. How does the success rate of fertilization and pregnancy using sperm retrieved from micro-TESE compare to other fertility treatments?
  5. What is the long-term health outlook for children conceived using sperm retrieved from micro-TESE?
  6. Are there any alternative treatments or procedures that I should consider before opting for micro-TESE?
  7. How soon after the procedure can I expect to resume normal activities and what is the recovery process like?
  8. Will I need any additional treatments or procedures following micro-TESE to achieve a successful pregnancy?
  9. Are there any lifestyle changes or precautions I should take before and after undergoing micro-TESE?
  10. How often will I need to follow up with you after the procedure and what signs or symptoms should I watch out for that may indicate a complication?

Reference

Authors: Achermann APP, Pereira TA, Esteves SC. Journal: Int Urol Nephrol. 2021 Nov;53(11):2193-2210. doi: 10.1007/s11255-021-02979-4. Epub 2021 Aug 19. PMID: 34410586