Human Reproduction, Vol. 14, No. 1, 131-135,
January 1999
© 1999 European Society of Human Reproduction and Embryology
Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision
James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital-Cornell University Medical College, New York, USA
Testicular sperm extraction (TESE) is often an effective method for sperm retrieval from men with non-obstructive azoospermia. However, TESE has been a blind procedure that does not identify the focal sperm-producing areas of the testicle until after tissue has been excised from the patient. Experience with a new technique of microdissection of testicular tubules is presented here that identifies sperm-containing regions before their removal. Identification of spermatogenically active regions of the testicle is possible by direct examination of the individual seminiferous tubules. The underlying concept for this technique is simple: seminiferous tubules containing many developing germ cells, rather than Sertoli cells alone, are likely to be larger and more opaque than tubules without sperm production. In a sequential series of TESE cases for men with non-obstructive azoospermia, the ability to find spermatozoa increased from 45% (10/22) to 63% (17/27) after introduction of the microdissection technique. Microdissected samples yielded an average of 160 000 spermatozoa per sample in only 9.4 mg of tissue, whereas only 64 000 spermatozoa were found in standard biopsy samples that averaged 720 mg in weight (P < 0.05 for all comparisons). For men where microdissection was attempted, successful identification of enlarged tubules was possible in 56% (15/27) of cases. However, spermatozoa were retrieved with microdissection TESE for six men in whom sperm retrieval was unsuccessful with standard TESE approaches (35% of all men with spermatozoa retrieved). These findings suggest that microdissection TESE can improve sperm retrieval for men with non-obstructive azoospermia over that achieved with previously described biopsy techniques.
Key words: microdissection/non-obstructive azoospermia/sperm extraction/tissue excision
1 To whom correspondence should be addressed at: Room F-907A, Department of Urology, New York Presbyterian Hospital-Cornell University Medical College, 525 East 68th Street, New York, NY 10021, USA
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. R. Greenhalgh, T. S. Griffith, and M. Wald The Use of Immunofluorescence in Microdissection Testicular Sperm Extraction J Androl, September 1, 2009; 30(5): 548 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Brown, K. Hwang, P. N. Schlegel, and P. L. Morris Small ubiquitin-related modifier (SUMO)-1, SUMO-2/3 and SUMOylation are involved with centromeric heterochromatin of chromosomes 9 and 1 and proteins of the synaptonemal complex during meiosis in men Hum. Reprod., December 1, 2008; 23(12): 2850 - 2857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Donoso, H. Tournaye, and P. Devroey Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review Hum. Reprod. Update, November 1, 2007; 13(6): 539 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ohta, Y. Sakaide, and T. Wakayama Generation of progeny via ICSI following enrichment of elongated spermatids from mouse testis by flow-cytometric cell sorting Hum. Reprod., June 1, 2007; 22(6): 1612 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Carmignani, F. Gadda, G. Gazzano, G. Ragni, A. Paffoni, F. Rocco, and G. M. Colpi Testicular sperm extraction in cancerous testicle in patients with azoospermia: A Case Report Hum. Reprod., April 1, 2007; 22(4): 1068 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.I. McLachlan, E. Rajpert-De Meyts, C.E. Hoei-Hansen, D.M. de Kretser, and N.E. Skakkebaek Histological evaluation of the human testis--approaches to optimizing the clinical value of the assessment: Mini Review Hum. Reprod., January 1, 2007; 22(1): 2 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Vernaeve, G. Verheyen, A. Goossens, A. Van Steirteghem, P. Devroey, and H. Tournaye How successful is repeat testicular sperm extraction in patients with azoospermia? Hum. Reprod., June 1, 2006; 21(6): 1551 - 1554. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hauser, L. Yogev, G. Paz, H. Yavetz, F. Azem, J. B. Lessing, and A. Botchan Comparison of Efficacy of Two Techniques for Testicular Sperm Retrieval in Nonobstructive Azoospermia: Multifocal Testicular Sperm Extraction Versus Multifocal Testicular Sperm Aspiration J Androl, January 1, 2006; 27(1): 28 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wald, L. S. Ross, G. S. Prins, J. Cieslak-Janzen, G. Wolf, and C. S. Niederberger Analysis of Outcomes of Cryopreserved Surgically Retrieved Sperm for IVF/ICSI J Androl, January 1, 2006; 27(1): 60 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hussein, Y. Ozgok, L. Ross, and C. Niederberger Clomiphene Administration for Cases of Nonobstructive Azoospermia: A Multicenter Study J Androl, November 1, 2005; 26(6): 787 - 791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Schiff, G. D. Palermo, L. L. Veeck, M. Goldstein, Z. Rosenwaks, and P. N. Schlegel Success of Testicular Sperm Injection and Intracytoplasmic Sperm Injection in Men with Klinefelter Syndrome J. Clin. Endocrinol. Metab., November 1, 2005; 90(11): 6263 - 6267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Fujita, A. Tsujimura, T. Takao, Y. Miyagawa, K. Matsumiya, M. Koga, M. Takeyama, H. Fujioka, K. Aozasa, and A. Okuyama Expression of inhibin {alpha}, glial cell line-derived neurotrophic factor and stem cell factor in Sertoli cell-only syndrome: relation to successful sperm retrieval by microdissection testicular sperm extraction Hum. Reprod., August 1, 2005; 20(8): 2289 - 2294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Mulhall, S. W. Ghaly, N. Aviv, and A. Ahmed The Utility of Optical Loupe Magnification for Testis Sperm Extraction in Men With Nonobstructive Azoospermia J Androl, March 1, 2005; 26(2): 178 - 181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Rossi, L. A.V. Pereira, L. de Santis, F. F. Pasqualotto, A. Iaconelli Jr, V. Ortiz, and E. Borges Jr Sperm retrieval techniques in rats with suppressed spermatogenesis by experimental cryptorchidism Hum. Reprod., February 1, 2005; 20(2): 443 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Binsaleh, K. Sircar, and P. T. K. Chan Feasibility of Simultaneous Testicular Microdissection for Sperm Retrieval and Ipsilateral Testicular Tumor Resection in Azoospermic Men J Androl, November 1, 2004; 25(6): 867 - 871. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Jequier Clinical andrology--still a major problem in the treatment of infertility Hum. Reprod., June 1, 2004; 19(6): 1245 - 1249. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Devroey and A. Van Steirteghem A review of ten years experience of ICSI Hum. Reprod. Update, January 1, 2004; 10(1): 19 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kamal, I. Fahmy, R. T. Mansour, A. M. Abou-Setta, G. I. Serour, and M. A. Aboulghar Selection of Individual Testicular Tubules From Biopsied Testicular Tissue With a Stereomicroscope Improves Sperm Retrieval Rate J Androl, January 1, 2004; 25(1): 123 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.V. Hopps, A. Mielnik, M. Goldstein, G.D. Palermo, Z. Rosenwaks, and P.N. Schlegel Detection of sperm in men with Y chromosome microdeletions of the AZFa, AZFb and AZFc regions Hum. Reprod., August 1, 2003; 18(8): 1660 - 1665. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Paz, R. Gamzu, and H. Yavetz Diagnosis of Nonobstructive Azoospermia: The Laboratory Perspective J Androl, March 1, 2003; 24(2): 167 - 169. [Full Text] [PDF]
|
|
|
|
|
|
A. Tsujimura, K. Matsumiya, Y. Miyagawa, A. Tohda, H. Miura, K. Nishimura, M. Koga, M. Takeyama, H. Fujioka, and A. Okuyama Conventional multiple or microdissection testicular sperm extraction: a comparative study Hum. Reprod., November 1, 2002; 17(11): 2924 - 2929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Friedler, A. Raziel, M. Schachter, D. Strassburger, O. Bern, and R. Ron-El Outcome of first and repeated testicular sperm extraction and ICSI in patients with non-obstructive azoospermia Hum. Reprod., September 1, 2002; 17(9): 2356 - 2361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sousa, N. Cremades, J. Silva, C. Oliveira, L. Ferraz, J.T. da Silva, P. Viana, and A. Barros Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids Hum. Reprod., July 1, 2002; 17(7): 1800 - 1810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. N. Kolettis The Evaluation and Management of the Azoospermic Patient J Androl, May 1, 2002; 23(3): 293 - 305. [Full Text] [PDF]
|
|
|
|
|
|
S. Coskun, A. Tbakhi, K. A. Jaroudi, M. Uzumcu, T. A. Merdad, and K. A. Al-Hussein Flow cytometric ploidy analysis of testicular biopsies from sperm-negative wet preparations Hum. Reprod., April 1, 2002; 17(4): 977 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Westlander, E. Ekerhovd, S. Granberg, N. Lycke, L. Nilsson, C. Werner, and C. Bergh Serial ultrasonography, hormonal profile and antisperm antibody response after testicular sperm aspiration Hum. Reprod., December 1, 2001; 16(12): 2621 - 2627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L.C. Demirel, O. Evirgen, K. Aydos, and C Unlu The impact of the source of spermatozoa used for ICSI on pronuclear morphology Hum. Reprod., November 1, 2001; 16(11): 2327 - 2332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Amer, T. A. Elnasser, S. E. Haggar, T. Mostafa, G. Abdel-Malak, and W. Zohdy May-Grunwald-Giemsa stain for detection of spermatogenic cells in the ejaculate: a simple predictive parameter for successful testicular sperm retrieval Hum. Reprod., July 1, 2001; 16(7): 1427 - 1432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Silber Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia Hum. Reprod., November 1, 2000; 15(11): 2278 - 2284. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Amer, A. Ateyah, R. Hany, and W. Zohdy Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations Hum. Reprod., March 1, 2000; 15(3): 653 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Amer, S. E. Haggar, T. Moustafa, T. A. El-Naser, and W. Zohdy Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition Hum. Reprod., December 1, 1999; 14(12): 3030 - 3034. [Abstract] [Full Text] [PDF]
|
|