Micro-testicular sperm extraction

The condition of nonobstructive azoospermia (NOA) defines men with testicular failure who have severely deficient sperm production with no sperm in the ejaculate. NOA is the underlying diagnosis in approximately 10% of men seeking fertility evaluation. On testicular biopsy, these patients demonstrate hypospermatogenesis, maturation arrest, or Sertoli cell-only pattern (germinal cell aplasia). NOA may be related to genetic causes, as in Klinefelter syndrome (KS) and XX-male syndrome, or may be acquired, as in testicular failure secondary to cryptorchidism or systemic chemotherapy administration. As recently as two decade ago, techniques were not available to assist patients with NOA conceive offspring and their options were limited to donor spermatazoa or child adoption. A remarkable series of four distinct advancements have dramatically advanced the field in recent years, and today it is possible even for men with Sertoli cell-only pattern to initiate pregnancy with medical assistance. In this chapter, we focus on considerations and techniques related to microscopic testicular sperm extraction (microdissection TESE). Microdissection TESE, a technique developed at New York-Presbyterian Hospital–Weill Cornell Medical Center, yields superior sperm retrieval rates and requires a minimal amount of testicular tissue compared with other methods of sperm extraction.