Surgical treatment of male infertility

OBJECTIVE: In the Czech Republic in the treatment of male infertility the most up-to-date technologies of assisted reproduction have also become the methods of choice: MESA--microsurgical epididymal sperm aspiration, TESE--testicular sperm extraction and ICSI--intracytoplasmic sperm injection. The objective of the present study was an attempt to find a reliable predictor of results of planned TESE as prediction of possible successful sperm extraction can prevent unnecessary ovarian stimulation. DESIGN: Retrospective analysis of a group of 202 men operated in the authors centre on account of azoospermia--65 patients with obstructive azoospermia and 137 patients with testicular azoospermia. SETTING: Andromeda, Biolab, Iscare IVF, Prague. METHOD: The following parameters were evaluated: testicular volume, FSH serum level and histological finding and their values were compared with results of TESE. RESULTS: Elevated FSH levels and low testicular volume do not rule out a positive result of TESE. The most accurate predictor is histological examination. Elongated spermatids were found in the histological material in 59.3% of the examined cases which correlates significantly with the 60.2% TESE yield in the evaluated group. CONCLUSION: The material assembled on operation was divided into three parts. One serves preparation of the perIerative native preparation, the second one is dispatched for histological examination and the largest part is frozen. Simultaneous collection of oocytes and sperm cells is done only in selected cases. The histological finding of elongated spermatids indicates a positive finding of sperm during TESE with an accuracy of 91%. Assessment of the causes of azoospermia, evaluation of the state of spermatogenesis and treatment are thus implemented by a single operation.