title: Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction.
abstract: OBJECTIVE
  To report the chance of sperm discovery in the laboratory when sperm were not identified in the operating room (OR).
  
  
  METHODS
  Clinical retrospective study.
  
  
  METHODS
  Department of urology at a tertiary university hospital.
  
  
  METHODS
  A total of 1,054 men with nonobstructive azoospermia who underwent microdissection testicular sperm extraction.
  
  
  METHODS
  Preoperative and intraoperative parameters were analyzed relative to the chance of sperm identification using a tissue digestion protocol in the laboratory if no sperm were observed in the OR.
  
  
  METHODS
  Sperm retrieval, clinical pregnancy, and live birth rates.
  
  
  RESULTS
  Sperm were found in the OR in 52.5% of the 1,054 men. Of the 501 men for whom sperm were not identified by andrologists in the OR, sperm were found in the laboratory for an additional 35 (7%). On multivariable logistic regression analysis, the presence of germ cells intraoperatively was the only predictor of identifying sperm in the laboratory after tissue digestion.
  
  
  CONCLUSIONS
  In men undergoing microdissection testicular sperm extraction, when sperm were not observed in the OR despite extensive mechanical processing, sperm were observed in the laboratory for 7% of the men. This information is valuable in counseling couples in the immediate postoperative period when no sperm were identified intraoperatively.
authors.affiliation: Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Reifsnyder
authors.forename: Campbell
authors.initials: C
authors.lastname: Bryson
authors.forename: Nikica
authors.initials: N
authors.lastname: Zaninovic
authors.forename: Deborah
authors.initials: D
authors.lastname: Liotta
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: Cook
authors.forename: June
authors.initials: J
authors.lastname: Hariprashad
authors.forename: Dina
authors.initials: D
authors.lastname: Weiss
authors.forename: Queenie
authors.initials: Q
authors.lastname: Neri
authors.forename: Gianpiero D
authors.initials: GD
authors.lastname: Palermo
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
mesh_terms: D053713:Azoospermia / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D016009:Chi-Square Distribution; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D018093:Gelatinases / Q000378:metabolism*; D006785:Hospitals, University; D006801:Humans; D050498:Live Birth; D016015:Logistic Models; D008297:Male; D042282:Microdissection; D009519:New York City; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013076:Sperm Count; D053625:Sperm Retrieval; D013737:Testis / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018093:Gelatinases