title: Microdissection testicular sperm extraction (micro-TESE) as a sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects.
abstract: BACKGROUND
  Rare foci of sperm production may be found in up to 60% of men with nonobstructive azoospermia (NOA). Sperm production, if present, is minimal for sperm appearance in the ejaculate. Given that there are no treatment options to restore fertility, sperm retrieval is the only alternative to find testicular sperm than then can be used for in vitro fertilization (IVF). Among sperm acquisition methods, micro-TESE has higher success rates at obtaining sperm compared with testicular sperm extraction and testicular sperm aspiration.
  
  
  METHODS
  This video describes the operative aspects of micro-TESE, performed on an outpatient basis, in a man with NOA and history of cryptorchidism in whom orchidopexy was performed at age 6. The concept of micro-TESE is to identify areas of sperm production within the testes with the aid of optical magnification (15-25X) and based on the size and appearance of the seminiferous tubules (ST).
  
  
  RESULTS
  Intraoperative findings revealed homogeneous pattern of collapsed STs in which an area containing dilated STs was clearly identified and extracted. Testicular tissue was then processed in the IVF laboratory to allow sperm search. In this case, micro-TESE was successful at obtaining testicular sperm for intracytoplasmic sperm injection (ICSI). Surplus retrieved testicular spermatozoa not used for ICSI was cryopreserved. The operative time was 120 minutes, and intraoperative blood loss was negligible. Postoperatively, the patient recovered to his normal activities within 5 days and no complications were recorded except for minor testicular pain and scrotal swelling.
  
  
  CONCLUSIONS
  Micro-TESE allowed the identification and extraction of sperm-containing STs with minimum tissue excision and marked reduction in time processing of testicular specimens for sperm injection.
authors.affiliation: ANDROFERT, Center for Male Reproduction, Campinas, SP, Brazil. s.esteves@androfert.com.br
authors.forename: Sandro C
authors.initials: SC
authors.lastname: Esteves
mesh_terms: D053713:Azoospermia; D006801:Humans; D008297:Male; D042282:Microdissection / Q000379:methods*; D015203:Reproducibility of Results; D053625:Sperm Retrieval; D013737:Testis / Q000601:surgery*