Comparison of Medical Results of Testicular Sperm Extraction by Conventional Surgery and Microsurgical Track (Microsperm)
Azoospermia
About this trial
This is an interventional supportive care trial for Azoospermia
Eligibility Criteria
Inclusion Criteria:
- 2 consecutive spermograms (with ±3 months interval) confirming absence of sperm (azoospermia)
- diagnosis of non-obstructive azoospermia on the basis of a complete history, physical examination, endocrine profile, ultrasound and chromosomal analysis
Exclusion Criteria:
- History of previous testicular surgery, except orchiopexy for undescended testis.
- Monochordy
- Ultrasound revealed testicular nodule
- Y chromosome microdeletions type AZFa and b.
Sites / Locations
- University Hospital
- University Hospital
- University Hospital
- University Hospital
- University HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
conventional TESE
micro TESE
Conventional multiple TESE is performed under general or locoregional anesthesia. Through a small vertical incision in the median scrotal raphe, the skin, dartos muscle, and tunica vaginalis are opened to expose the tunica albuginea. The tunica albuginea is ordinarily incised for about 4 mm at the medium region of the testis. A similar biopsy will be systematically performed in the contralateral testis. The biopsy is analyzed by the biologist in the theatre in order to precise if sufficient spermatozoa is retrieved.
Microdissection TESE is also performed under general or locoregional anesthesia. After the tunica albuginea is opened widely along the antiepididymal border, direct examination of the testicular parenchyma is performed under the operating microscope. An attempt is made to identify individual seminiferous tubules that are larger, more opaque and whiter than other tubules in the testicular parenchyma, which are considered to contain spermatozoa. The extracted tubules are analyzed by the biologist in the theatre. The procedure is terminated when sperm are retrieved or further biopsy is thought likely to jeopardize the blood supply of the testis. If all tubules are seen to have an identical morphological appearance, at least three samples (upper, middle, and lower) are obtained. A similar microTESE will be systematically performed in the contralateral testis