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Male Infertility


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In difficult cases, when no larger tubules are visible on the two surfaces of the shell-like opened testis, we insinuate our Vannas forceps more deeply along the septa, delicately detaching many lobules from the surrounding ones, almost reaching the opposite tunica albuginea, thoroughly probing the whole underlying parenchyma.

The larger, or apparently larger, tubules are retrieved and passed to the biologist assisting the operation, for an immediate meticulous sperm search. At the end, testicular tissue is irrigated with Ringer solution plus gentamycin. Haemostasis is mainly performed by gentle pressure on the parenchyma for ' using a gauze wet with antibiotic and, only if strictly necessary, using the bipolar thermal device 0. Albugineal incision is repaired with continuous suture VicrylTM or , ideally limited to the external half of its thickness, then followed by closure of tunica vaginalis, infusion of betamethasone solution into vaginal cavity to prevent pain and adhesions, and closure of dartos and skin.

If surgery has been made meticulously, post-operative progress is actually painless, and any scar will become invisible at sonography three months later Colpi, Success depends maximally on the microsurgeon's experience, because MicroTESE has a very long learning curve, with satisfying SRR beyond the first cases Ishikawa, ; Schlegel claims that SRR goes on improving very slowly until overstepping a case-threshold, because eyes succeed in seizing even minimal differences in tubular diameter Dabaja, Compared to multiple TESE, which is believed to be more dangerous for testis, due to possible blood supply lesions Schlegel, or intratesticular edema or hematoma Silber, , MicroTESE is now considered the safer procedure, with a lower incidence of bleeding Schlegel, ; Okada, and postoperative complications such as hematomas, fibrosis and reduced orchidometry, as assessed by sonography Amer, ; Okada, ; Ramasamy, ; Deruyver, In our series of MicroTESE, only one hematoma occurred due to hemostasis during hypotensive state, not communicated by anesthesiologist, and successfully treated without any subsequent damage ; no infection, no post-surgical testis hypotrophy or pain, not even in cases where we performed two MicroTESE on the same testis to increase parenchyma exploration.

Furthermore, no differences versus TESE were shown about possible post-operative hypotestosteronemia Okada, ; Ramasamy, ; Deruyver, Hormonal presurgical treatment is under debate. There is some evidence that a small percentage of men with azoospermia due to testicular failure may benefit from treatment of a clinical varicocele Colpi, ; Inci, ; Weedin, About half of NOA patients are hypogonadic, and require endocrine post-surgical follow-up, and testosterone replacement when needed Bobjer, The laboratory management of these specimens requires special attention, because NOA spermatozoa are often compromised in quality and more fragile than ejaculated ones Esteves, When only immotile spermatozoa are obtained after processing of fresh or cryo-thawed specimens, different methods HOS test, sperm tail flexibility test, and pentoxifylline stimulation can be used to differentiate live immotile from dead spermatozoa Esteves, Vitrification seems to be a suitable method to cryopreserve sperms from poor positive retrievals Endo, ICSI performed using fresh or cryo-thawed sperm seems to achieve similar results, whilst live birth rates are significantly lower in the NOA Sometimes dilated tubules can be easily identified, even at lower magnification.

Sometimes higher magnification allows better identification of dilated tubules. Other times tubular dilation can be identified only at higher magnification.

Guidelines of Male Infertility. EAU Guidelines, , p 9. Hum Reprod ; 14 1: Optimal number of biopsies and impact of testicular histology on the outcome of testicular sperm extraction. Urol J ; Physiological consequences of testicular sperm extraction. Hum Reprod ; Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: Fertil Steril ; Microdissection testicular sperm extraction: Asian J Androl ; Comparison of sperm retrieval and intracytoplasmic sperm injection outcome in patients with and without Klinefelter syndrome.

Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol ; Ramasamy R1, Schlegel PN. Salvage micro-dissection testicular sperm extraction; outcome in men with non-obstructive azoospermia with previous failed sperm retrievals.

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Other web material, substrate or products are treatable in similar processes, existent laser perforation, treatment machines are able to modify with new optical, micro mechanical and control elements. Kompaktanlagen wurden bereits in den er und er Jahren verwendet und damals noch von oben bedient.

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