Skip to main content
SpringerLink
Log in

Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature

  • Urology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Nonobstructive azoospermia (NOA) is associated with intrinsic testicular defects that severely impair sperm production. Although NOA invariably leads to infertility, focal sperm production may exist in the testicles of affected patients, which can be retrieved and used for intracytoplasmic sperm injection (ICSI) to generate healthy offspring. However, geographic locations of testicular sperm producing-areas are uncertain, making microsurgical-guided sperm retrieval (microdissection testicular sperm extraction; micro-TESE) an attractive method to identify and retrieve sperm in patients with NOA due to spermatogenic failure. Given the widespread use of micro-TESE, its effectiveness in harvesting sperm and related potential complications need to be clarified.

Methods

We queried PubMed/MEDLINE for studies published in English, from inception to May 2021, concerning the effect of micro-TESE on sperm retrieval rate (SRR), complication rate and ICSI pregnancy rate—using retrieved testicular sperm in subfertile couples where the male had NOA.

Results

We found 116 articles, including 70 original papers, 32 review articles, and 14 systematic reviews. The evidence accounted for 4895 patients. Micro-TESE retrieved sperm in 46.6% of men with NOA, but SRRs varied considerably (18.4–70.8%) and were mainly related to the treated population characteristics. Concerning the general population of NOA patients who have not undergone previous sperm retrieval (naïve population), the SRR by micro-TESE was 46.8% (1833 of 3914 patients; range 20–70.8%; 28 studies). In studies reporting SR by micro-TESE for men who had failed percutaneous testicular sperm aspiration or non-microsurgical testicular sperm extraction, the SRR was 39.1% (127 of 325 patients; range 18.4–57.1%; 4 studies). Data on adverse events indicated that micro-TESE was associated with low (~ 3%) short-term postoperative complication rates. The fertilizing ability of testicular sperm retrieved by micro-TESE and used for ICSI was adequate (~ 57%), whereas clinical pregnancy and live birth were obtained in 39% and 24% of couples who had an embryo transfer, respectively. The health of the resulting children seems reassuring, but the evidence is limited. The procedure increases sperm retrieval success compared to non-microsurgical retrieval methods, particularly in men with Sertoli cell-only testicular histopathology.

Conclusion

We concluded that micro-TESE is an effective and safe method to retrieve sperm from men with NOA-related infertility, with potential advantages over non-microsurgical methods. Nevertheless, high-quality, head-to-head comparative randomized controlled trials by sperm retrieval method, focusing on SRR, live birth rate and assessing long-term adverse events and health of children conceived using testicular sperm from NOA patients are lacking. Therefore, further research is required to determine the full clinical implications of micro-TESE in male infertility treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All data underlying the results are available as part of the article and no additional data source is required.

References

  1. Kumar N, Singh AK (2015) Trends of male factor infertility, an important cause of infertility: a review of literature. J Hum Reprod Sci 8:191–196

    Article  PubMed  PubMed Central  Google Scholar 

  2. Esteves SC, Miyaoka R, Agarwal A (2011) An update on the clinical assessment of the infertile male. Clinics 66:691–700

    Article  PubMed  PubMed Central  Google Scholar 

  3. Agarwal A, Mulgund A, Hamada A, Chyatte MR (2015) A unique view on male infertility around the globe. Reprod Biol Endocrinol 13:1–9

    Article  CAS  Google Scholar 

  4. Esteves SC (2015) Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl 17:459–470

    Article  PubMed  PubMed Central  Google Scholar 

  5. Esteves SC, Miyaoka R, Agarwal A (2011) Surgical treatment of male infertility in the era of intracytoplasmic sperm injection—new insights. Clinics (Sao Paulo) 66:1463–1478

    Article  Google Scholar 

  6. Miyaoka R, Esteves SC (2013) Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role? Clinics (Sao Paulo) 68(Suppl 1):111–119

    Article  Google Scholar 

  7. Tharakan T, Luo R, Jayasena CN, Minhas S (2021) Non-obstructive azoospermia: current and future perspectives. Fac Rev 10:7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fraietta R, Zylberstejn DS, Esteves SC (2013) Hypogonadotropic hypogonadism revisited. Clinics (Sao Paulo) 68(Suppl 1):81–88

    Article  Google Scholar 

  9. Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G et al (2019) Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update 25:733–757

    Article  PubMed  Google Scholar 

  10. Esteves SC, Ramasamy R, Colpi GM, Carvalho JF, Schlegel PN (2020) Sperm retrieval rates by micro-TESE versus conventional TESE in men with non-obstructive azoospermia-the assumption of independence in effect sizes might lead to misleading conclusions. Hum Reprod Update 26:603–605

    Article  PubMed  Google Scholar 

  11. Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P (2018) Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 15:535–562

    Article  CAS  PubMed  Google Scholar 

  12. Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC (1994) Andrology: Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 9:1705–1709

    Article  CAS  PubMed  Google Scholar 

  13. Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M et al (1995) Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 10:1457–1460

    Article  CAS  PubMed  Google Scholar 

  14. Gil-Salom M, Romero J, Rubio C, Ruiz A, Remohí J, Pellicer A (2000) Intracytoplasmic sperm injection with cryopreserved testicular spermatozoa. Mol Cell Endocrinol 169(1–2):15–19

    Article  CAS  PubMed  Google Scholar 

  15. Schroeder-Printzen I (2000) Microsurgical epididymal sperm aspiration: aspirate analysis and straws available after cryopreservation in patients with non-reconstructable obstructive azoospermia. Hum Reprod 15:2531–2535

    Article  CAS  PubMed  Google Scholar 

  16. Miyaoka R, Orosz JE, Achermann AP, Esteves SC (2019) Methods of surgical sperm extraction and implications for assisted reproductive technology success. Panminerva Med 61:164–177

    Article  PubMed  Google Scholar 

  17. Schlegel PN (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14:131–135

    Article  CAS  PubMed  Google Scholar 

  18. Dabaja AA, Schlegel PN (2013) Microdissection testicular sperm extraction: an update. Asian J Androl 15:35–39

    Article  PubMed  Google Scholar 

  19. Esteves SC, Varghese AC (2012) Laboratory handling of epididymal and testicular spermatozoa: what can be done to improve sperm injections outcome. J Hum Reprod Sci 5:233–243

    Article  PubMed  PubMed Central  Google Scholar 

  20. Esteves SC, Verza S Jr (2019) PESA/TESA/TESE sperm processing. In: Nagy Z, Varghese A, Agarwal A (eds) Practical manual of in vitro fertilization, 2nd edn. Springer, New York, pp 202–220

    Google Scholar 

  21. Mostafa T, Labib I, El-Khayat Y, El-Rahman El-Shahat A, Gadallah A (2008) Human testicular arterial supply: gross anatomy, corrosion cast, and radiologic study. Fertil Steril 90:2226–2230

    Article  PubMed  Google Scholar 

  22. Pais D, Fontoura P, Esperança-Pina JA (2004) The transmediastinal arteries of the human testis: an anatomical study. Surg Radiol Anat 26:379–383

    CAS  PubMed  Google Scholar 

  23. Esteves SC (2013) Microdissection testicular sperm extraction (micro-TESE) as a sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects. Int Braz J Urol 39:440–441

    Article  PubMed  Google Scholar 

  24. Janosek-Albright KJC, Schlegel PN, Dabaja AA (2015) Testis sperm extraction. Asian J Urol 2:79–84

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ashraf MC, Singh S, Raj D, Ramakrishnan S, Esteves SC (2013) Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: technique and preliminary results in India. J Hum Reprod Sci 6:111–123

    Article  PubMed  PubMed Central  Google Scholar 

  26. Westlander G (2020) Utility of micro-TESE in the most severe cases of non-obstructive azoospermia. Ups J Med Sci 125:99–103

    Article  PubMed  PubMed Central  Google Scholar 

  27. Turunc T, Gul U, Haydardedeoglu B, Bal N, Kuzgunbay B, Peskircioglu L et al (2010) Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study. Fertil Steril 94:2157–2160

    Article  PubMed  Google Scholar 

  28. Komori K, Tsujimura A, Miura H, Shin M, Takada T, Honda M et al (2004) Serial follow-up study of serum testosterone and antisperm antibodies in patients with non-obstructive azoospermia after conventional or microdissection testicular sperm extraction. Int J Androl 27:32–36

    Article  CAS  PubMed  Google Scholar 

  29. Ishikawa T (2012) Surgical recovery of sperm in non-obstructive azoospermia. Asian J Androl 14:109–115

    Article  PubMed  Google Scholar 

  30. Mårin P, Holmäng S, Jönsson L, Sjöström L, Kvist H, Holm G et al (1992) The effects of testosterone treatment on body composition and metabolism in middle-aged obese men. Int J Obes Relat Metab Disord 16:991–997

    PubMed  Google Scholar 

  31. Ishikawa T, Yamaguchi K, Kondo Y, Takenaka A, Fujisawa M (2008) Metabolic syndrome in men with Klinefelter’s syndrome. Urology 71:1109–1113

    Article  PubMed  Google Scholar 

  32. Chan PT, Palermo GD, Veeck LL, Rosenwaks Z, Schlegel PN (2001) Testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of men with persistent azoospermia postchemotherapy. Cancer 92:1632–1637

    Article  CAS  PubMed  Google Scholar 

  33. Tsujimura A, Matsumiya K, Takao T, Miyagawa Y, Koga M, Takeyama M, Fujioka H, Okuyama A (2004) Clinical analysis of patients with azoospermia factor deletions by microdissection testicular sperm extraction. Int J Androl 27:76–81

    Article  PubMed  Google Scholar 

  34. Aydos K, Demirel LC, Baltaci V, Unlü C (2005) Enzymatic digestion plus mechanical searching improves testicular sperm retrieval in non-obstructive azoospermia cases. Eur J Obstet Gynecol Reprod Biol 120:80–86

    Article  PubMed  Google Scholar 

  35. Tsujimura A, Miyagawa Y, Takao T, Takada S, Koga M, Takeyama M, Matsumiya K, Fujioka H, Okuyama A (2006) Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol 175:1446–1449

    Article  PubMed  Google Scholar 

  36. Hibi H, Ohori T, Yamada Y, Honda N, Hashiba Y, Asada Y (2007) Testicular sperm extraction and ICSI in patients with post-chemotherapy non-obstructive azoospermia. Arch Androl 53:63–65

    Article  CAS  PubMed  Google Scholar 

  37. Kanto S, Sugawara J, Masuda H, Sasano H, Arai Y, Kyono K (2008) Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients. Fertil Steril 90:2010.e5–7

    Article  Google Scholar 

  38. Madbouly K, Alaskar A, Al Matrafi H (2008) Sensitivity, specificity and accuracy of intraoperative findings in microdissection testicular sperm extraction: a prospective study. Curr Urol 2:130–134

    Article  Google Scholar 

  39. El-Haggar S, Mostafa T, Abdel Nasser T, Hany R, Abdel Hadi A (2008) Fine needle aspiration vs. mTESE in non-obstructive azoospermia. Int J Androl 31:595–601

    Article  CAS  PubMed  Google Scholar 

  40. Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R (2008) Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 40:219–226

    Article  CAS  PubMed  Google Scholar 

  41. Ishikawa T, Nose R, Yamaguchi K, Chiba K, Fujisawa M (2010) Learning curves of microdissection testicular sperm extraction for nonobstructive azoospermia. Fertil Steril 94:1008–1011

    Article  PubMed  Google Scholar 

  42. Hsiao W, Stahl PJ, Osterberg EC, Nejat E, Palermo GD, Rosenwaks Z, Schlegel PN (2011) Successful treatment of postchemotherapy azoospermia with microsurgical testicular sperm extraction: the Weill Cornell experience. J Clin Oncol 29:1607–1611

    Article  PubMed  Google Scholar 

  43. Ando M, Yamaguchi K, Chiba K, Miyake H, Fujisawa M (2012) Expression of VASA mRNA in testis as a significant predictor of sperm recovery by microdissection testicular sperm extraction in patient with nonobstructive azoospermia. J Androl 33:711–716

    Article  CAS  PubMed  Google Scholar 

  44. Berookhim BM, Palermo GD, Zaninovic N, Rosenwaks Z, Schlegel PN (2014) Microdissection testicular sperm extraction in men with Sertoli cell-only testicular histology. Fertil Steril 102:1282–1286

    Article  PubMed  PubMed Central  Google Scholar 

  45. Esteves SC, Prudencio C, Seol B, Verza S, Knoedler C, Agarwal A (2014) Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility. Asian J Androl 16:602–606

    Article  PubMed  PubMed Central  Google Scholar 

  46. Karacan M, Ulug M, Arvas A, Cebi Z, Erkan S, Camlıbel T (2014) Live birth rate with repeat microdissection TESE and intracytoplasmic sperm injection after a conventional testicular biopsy in men with nonobstructive azoospermia. Eur J Obstet Gynecol Reprod Biol 183:174–177

    Article  PubMed  Google Scholar 

  47. Yildirim ME, Koc A, Kaygusuz IC, Badem H, Karatas OF, Cimentepe E, Unal D (2014) The association between serum follicle-stimulating hormone levels and the success of microdissection testicular sperm extraction in patients with azoospermia. Urol J 11:1825–1828

    PubMed  Google Scholar 

  48. Aydin T, Sofikerim M, Yucel B, Karadag M, Tokat F (2015) Effects of testicular histopathology on sperm retrieval rates and ICSI results in non-obstructive azoospermia. J Obstet Gynaecol 35:829–831

    Article  CAS  PubMed  Google Scholar 

  49. Kalsi JS, Shah P, Thum Y, Muneer A, Ralph DJ, Minhas S (2015) Salvage micro-dissection testicular sperm extraction; outcome in men with non-obstructive azoospermia with previous failed sperm retrievals. BJU Int 116:460–465

    Article  CAS  PubMed  Google Scholar 

  50. Alfano M, Ventimiglia E, Locatelli I, Capogrosso P, Cazzaniga W, Pederzoli F et al (2017) Anti-Mullerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia. Sci Rep 7:17638

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Binsaleh S, Alhajeri D, Madbouly K (2017) Microdissection testicular sperm extraction in men with nonobstructive azoospermia: experience of King Saud University Medical City, Riyadh, Saudi Arabia. Urol Ann 9:136–140

    Article  PubMed  PubMed Central  Google Scholar 

  52. Eken A, Gulec F (2018) Microdissection testicular sperm extraction (micro-TESE): predictive value of preoperative hormonal levels and pathology in non-obstructive azoospermia. Kaohsiung J Med Sci 34:103–108

    Article  PubMed  Google Scholar 

  53. Chihara M, Ogi K, Ishiguro T, Yoshida K, Godo C, Takakuwa K, Enomoto T (2018) Microdissection testicular sperm extraction in five Japanese patients with non-mosaic Klinefelter’s syndrome. Reprod Med Biol 17:209–216

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Eelaminejad Z, Favaedi R, Modarresi T, Sabbaghian M, Sadighi Gilani MA, Shahhoseini M (2018) Association between JMJD1A expression and sperm retrieval in non-obstructive azoospermic patients. Cell J 19:660–665

    PubMed  Google Scholar 

  55. Chen X, Ma Y, Zou S, Wang S, Qiu J, Xiao Q, Zhou L, Ping P (2019) Comparison and outcomes of nonobstructive azoospermia patients with different etiology undergoing MicroTESE and ICSI treatments. Transl Androl Urol 8:366–373

    Article  PubMed  PubMed Central  Google Scholar 

  56. Ortac M, Cilesiz NC, Demirelli E, Aydin R, Savun M, Ermec B, Kadioglu A (2020) Undescended testis does not affect the outcome of microdissection testicular sperm extraction. Urology 141:77–81

    Article  PubMed  Google Scholar 

  57. Zhang H, Xi Q, Zhang X, Zhang H, Jiang Y, Liu R, Yu Y (2020) Prediction of microdissection testicular sperm extraction outcome in men with idiopathic nonobstruction azoospermia. Medicine (Baltimore) 99:e19934

    Article  CAS  Google Scholar 

  58. Özman O, Tosun S, Bayazıt N, Cengiz S, Bakırcıoğlu ME (2021) Efficacy of the second micro-testicular sperm extraction after failed first micro-testicular sperm extraction in men with nonobstructive azoospermia. Fertil Steril 115:915–921

    Article  PubMed  Google Scholar 

  59. Kavoussi PK, West BT, Chen SH, Hunn C, Gilkey MS, Machen GL, Kavoussi KM, Esqueda A, Wininger JD, Kavoussi SK (2020) A comprehensive assessment of predictors of fertility outcomes in men with non-obstructive azoospermia undergoing microdissection testicular sperm extraction. Reprod Biol Endocrinol 18:90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Okada H, Dobashi M, Yamazaki T, Hara I, Fujisawa M, Arakawa S, Kamidono S (2002) Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 168:1063–1067

    Article  PubMed  Google Scholar 

  61. Tsujimura A, Matsumiya K, Miyagawa Y, Tohda A, Miura H, Nishimura K et al (2002) Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 17:2924–2929

    Article  CAS  PubMed  Google Scholar 

  62. Ramasamy R, Yagan N, Schlegel PN (2005) Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 65:1190–1194

    Article  PubMed  Google Scholar 

  63. Ghalayini IF, Al-Ghazo MA, Hani OB, Al-Azab R, Bani-Hani I, Zayed F et al (2011) Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res 3:124–131

    PubMed  PubMed Central  Google Scholar 

  64. Colpi GM, Colpi EM, Piediferro G, Giacchetta D, Gazzano G, Castiglioni FM et al (2009) Microsurgical TESE versus conventional TESE for ICSI in non-obstructive azoospermia: a randomized controlled study. Reprod Biomed Online 18:315–319

    Article  PubMed  Google Scholar 

  65. Majzoub A, Arafa M, Al Said S, Agarwal A, Seif A, Al Naimi A, El Bardisi H (2016) Outcome of testicular sperm extraction in nonmosaic Klinefelter syndrome patients: what is the best approach? Andrologia 48:171–176

    Article  CAS  PubMed  Google Scholar 

  66. Maglia E, Boeri L, Fontana M, Gallioli A, De Lorenzis E, Palmisano F et al (2018) Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: understanding which treatment works for which patient. Arch Ital Urol Androl 90:130–135

    Article  CAS  PubMed  Google Scholar 

  67. Deruyver Y, Vanderschueren D, Van der Aa F (2014) Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2:20–24

    Article  CAS  PubMed  Google Scholar 

  68. Bernie AM, Mata DA, Ramasamy R, Schlegel PN (2015) Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril 104:1099-1103.e3

    Article  PubMed  Google Scholar 

  69. Donoso P, Tournaye H, Devroey P (2007) Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 13:539–549

    Article  CAS  PubMed  Google Scholar 

  70. Esteves SC, Agarwal A (2013) Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review. Clinics (Sao Paulo) 68(Suppl 1):141–150

    Article  Google Scholar 

  71. Esteves SC, Yarali H, Ubaldi FM, Carvalho JF, Bento FC, Vaiarelli A et al (2020) Validation of ART calculator for predicting the number of metaphase II oocytes required for obtaining at least one euploid blastocyst for transfer in couples undergoing in vitro fertilization/intracytoplasmic sperm injection. Front Endocrinol (Lausanne) 10:917

    Article  Google Scholar 

  72. Esteves SC, Carvalho JF, Bento FC, Santos J (2019) A novel predictive model to estimate the number of mature oocytes required for obtaining at least one euploid blastocyst for transfer in couples undergoing in vitro fertilization/intracytoplasmic sperm injection: the ART calculator. Front Endocrinol (Lausanne) 10:99

    Article  Google Scholar 

  73. Ohlander S, Hotaling J, Kirshenbaum E, Niederberger C, Eisenberg ML (2014) Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: A meta-analysis. Fertil Steril 101:344–349

    Article  PubMed  Google Scholar 

  74. Krawetz SA (2005) Paternal contribution: New insights and future challenges. Nat Rev Genet 6:633–642

    Article  CAS  PubMed  Google Scholar 

  75. Meijerink AM, Ramos L, Janssen AJWM, Maas-van Schaaijk NM, Meissner A, Repping S et al (2016) Behavioral, cognitive, and motor performance and physical development of five-year-old children who were born after intracytoplasmic sperm injection with the use of testicular sperm. Fertil Steril 106:1673-1682.e5

    Article  PubMed  Google Scholar 

  76. Sandin S, Nygren K-G, Iliadou A, Hultman CM, Reichenberg A (2013) Autism and mental retardation among offspring born after in vitro fertilization. JAMA 310:75–84

    Article  CAS  PubMed  Google Scholar 

  77. Mahesan AM, Sadek S, Moussavi V, Vazifedan T, Majeed A, Cunningham T, Oehninger S, Bocca S (2018) Clinical outcomes following ICSI cycles using surgically recovered sperm and the impact of maternal age: 2004–2015 SART CORS registry. J Assist Reprod Genet 35:1239–1246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Klami R, Mankonen H, Perheentupa A (2018) Successful microdissection testicular sperm extraction for men with non-obstructive azoospermia. Reprod Biol 18:137–142

    Article  PubMed  Google Scholar 

  79. Bernie AM, Ramasamy R, Schlegel PN (2013) Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl 23:5

    Article  PubMed  PubMed Central  Google Scholar 

  80. Carpi A, Sabanegh E, Mechanick J (2009) Controversies in the management of nonobstructive azoospermia. Fertil Steril 91:963–970

    Article  PubMed  Google Scholar 

  81. Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ et al (2018) Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl 20:30–36

    Article  CAS  PubMed  Google Scholar 

  82. Boitrelle F, Robin G, Marcelli F, Albert M, Leroy-Martin B, Dewailly D et al (2011) A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study. Hum Reprod 26:3215–3221

    Article  CAS  PubMed  Google Scholar 

  83. Ramasamy R, Padilla WO, Osterberg EC, Srivastava A, Reifsnyder JE, Niederberger C et al (2013) A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 189:638–642

    Article  PubMed  Google Scholar 

  84. Raman JD, Schlegel PN (2003) Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism. J Urol 170(4 Pt 1):1287–1290

    Article  PubMed  Google Scholar 

  85. Verza S, Esteves SC (2011) Microsurgical versus conventional single-biopsy testicular sperm extraction in nonobstructive azoospermia: a prospective controlled study. Fertil Steril 96:S53

    Article  Google Scholar 

  86. Arshad MA, Majzoub A, Esteves SC (2020) Predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature. Int Urol Nephrol 52:2015–2038

    Article  PubMed  Google Scholar 

  87. Bryson CF, Ramasamy R, Sheehan M, Palermo GD, Rosenwaks Z, Schlegel PN (2014) Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction. J Urol 191:175–178

    Article  PubMed  Google Scholar 

  88. Nariyoshi S, Nakano K, Sukegawa G, Sho T, Tsuji Y (2020) Ultrasonographically determined size of seminiferous tubules predicts sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia. Fertil Steri 113:97-104.e2

    Article  CAS  Google Scholar 

  89. Simoni M, Tüttelmann F, Gromoll J, Nieschlag E (2008) Clinical consequences of microdeletions of the Y chromosome: the extended Münster experience. Reprod Biomed Online 16:289–303

    Article  CAS  PubMed  Google Scholar 

  90. Krausz C (2005) Y chromosome and male infertility. Andrologia 37:219–223

    Article  CAS  PubMed  Google Scholar 

  91. Hamada AJ, Esteves SC, Agarwal A (2013) A comprehensive review of genetics and genetic testing in azoospermia. Clinics (Sao Paulo) 68(Suppl 1):39–60

    Article  Google Scholar 

  92. Salonia A, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioǧlu A et al (2021) European Association of Urology Guidelines on Sexual and Reproductive Health. Available from: https://uroweb.org/guideline/sexual-and-reproductive-health/. Accessed 30 May 2021

  93. Krausz C, Quintana-Murci L, McElreavey K (2000) Prognostic value of Y deletion analysis: what is the clinical prognostic value of Y chromosome microdeletion analysis? Hum Reprod 15:1431–1434

    Article  CAS  PubMed  Google Scholar 

  94. Shiraishi K, Ohmi C, Shimabukuro T, Matsuyama H (2012) Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia. Hum Reprod 27:331–339

    Article  CAS  PubMed  Google Scholar 

  95. Sussman EM, Chudnovsky A, Niederberger CS (2008) Hormonal evaluation of the infertile male: has it evolved? Urol Clin N Am 35:147–155

    Article  Google Scholar 

  96. Laursen RJ, Elbaek HO, Povlsen BB, Lykkegaard J, Jensen KBS, Esteves SC et al (2019) Hormonal stimulation of spermatogenesis: a new way to treat the infertile male with non-obstructive azoospermia? Int Urol Nephrol 51:453–456

    Article  PubMed  Google Scholar 

  97. Esteves SC, Miyaoka R, Roque M, Agarwal A (2016) Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl 18:246–253

    Article  PubMed  Google Scholar 

  98. Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM (2016) Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril 106:1338–1343

    Article  PubMed  Google Scholar 

  99. Esteves SC, Glina S (2005) Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol 31:541–548

    Article  PubMed  Google Scholar 

  100. Agarwal A, Hamada A, Esteves SC (2012) Insight into oxidative stress in varicocele-associated male infertility: part 1. Nat Rev Urol 9:678–690

    Article  PubMed  CAS  Google Scholar 

  101. Hamada A, Esteves SC, Agarwal A (2013) Insight into oxidative stress in varicocele-associated male infertility: part 2. Nat Rev Urol 10:26–37

    Article  CAS  PubMed  Google Scholar 

  102. Esteves SC (2019) Pro: should varicocele be repaired in azoospermic infertile men? In: Esteves S, Cho CL, Majzoub A, Agarwal A (eds) Varicocele and male infertility. Springer, Cham

    Chapter  Google Scholar 

  103. Figueira RCS, Verza S, Moreno VCF, Esteves SC (2020) Effect of pentoxifylline supplementation routinely added to sperm suspensions immediately before intracytoplasmic sperm injection. Fertil Steril 114(Suppl):e114–e115

    Article  Google Scholar 

  104. Crabbé E, Verheyen G, Tournaye H, Van Steirteghem A (1997) The use of enzymatic procedures to recover testicular germ cells. Hum Reprod 12:1682–1687

    Article  PubMed  Google Scholar 

  105. Ramasamy R, Reifsnyder JE, Bryson C, Zaninovic N, Liotta D, Cook CA, Hariprashad J, Weiss D, Neri Q, Palermo GD, Schlegel PN (2011) Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction. Fertil Steril 96:299–302

    Article  PubMed  Google Scholar 

  106. Baukloh V (2002) German Society for Human Reproductive Biology. Retrospective multicentre study on mechanical and enzymatic preparation of fresh and cryopreserved testicular biopsies. Hum Reprod 17:1788–1794

    Article  PubMed  Google Scholar 

  107. Modarresi T, Sabbaghian M, Shahverdi A, Hosseinifar H, Akhlaghi AA, Sadighi Gilani MA (2013) Enzymatic digestion improves testicular sperm retrieval in nonobstructive azoospermic patients. Iran J Reprod Med 11:447–452

    PubMed  PubMed Central  Google Scholar 

  108. Coetzee K, Ozgur K, Berkkanoglu M, Bulut H, Isikli A (2016) Reliable single sperm cryopreservation in Cell Sleepers for azoospermia management. Andrologia 48:203–210

    Article  CAS  PubMed  Google Scholar 

  109. Esteves SC (2016) Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 33:1319–1335

    Article  PubMed  PubMed Central  Google Scholar 

  110. Endo Y, Fujii Y, Shintani K, Seo M, Motoyama H, Funahashi H (2012) Simple vitrification for small numbers of human spermatozoa. Reprod Biomed Online 24:301–307

    Article  CAS  PubMed  Google Scholar 

  111. Yu Z, Wei Z, Yang J, Wang T, Jiang H, Li H, Tang Z, Wang S, Liu J (2018) Comparison of intracytoplasmic sperm injection outcome with fresh versus frozen-thawed testicular sperm in men with nonobstructive azoospermia: a systematic review and meta-analysis. J Assist Reprod Genet 35:1247–1257

    Article  PubMed  PubMed Central  Google Scholar 

  112. Flannigan RK, Schlegel PN (2019) Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue processing. Fertil Steril 111:420–426

    Article  PubMed  Google Scholar 

  113. Flannigan R, Bach PV, Schlegel PN (2017) Microdissection testicular sperm extraction. Transl Androl Urol 6:745–752

    Article  PubMed  PubMed Central  Google Scholar 

  114. Punjani N, Kang C, Schlegel PN (2021) Two decades from the introduction of microdissection testicular sperm extraction: how this surgical technique has improved the management of NOA. J Clin Med 10:1374

    Article  PubMed  PubMed Central  Google Scholar 

  115. Corona G, Pizzocaro A, Lanfranco F, Garolla A, Pelliccione F, Vignozzi L et al (2017) Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update 23:265–275

    Article  CAS  PubMed  Google Scholar 

  116. Shah R, Gupta C (2017) Advances in sperm retrieval techniques in azoospermic men: a systematic review. Arab J Urol 16:125–131

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado 1464, Campinas, SP, 13075-460, Brazil

    Arnold P. P. Achermann & Sandro C. Esteves

  2. Post-Graduation Program in Surgical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil

    Arnold P. P. Achermann & Thairo A. Pereira

  3. Urocore-Centro de Urologia e Fisioterapia Pélvica, Londrina, PR, Brazil

    Arnold P. P. Achermann

  4. Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil

    Sandro C. Esteves

  5. Faculty of Health, Aarhus University, Aarhus, Denmark

    Sandro C. Esteves

Authors
  1. Arnold P. P. Achermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thairo A. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandro C. Esteves
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AA and TP performed the literature search. AA and SCE assessed the retrieved articles for inclusion. AA, TP and SCE drafted the manuscript. SCE critically reviewed the manuscript. All authors approved the submitted version.

Corresponding author

Correspondence to Sandro C. Esteves.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Achermann, A.P.P., Pereira, T.A. & Esteves, S.C. Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. Int Urol Nephrol 53, 2193–2210 (2021). https://doi.org/10.1007/s11255-021-02979-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-021-02979-4

Keywords

Search

Navigation