21/05/2023
INFERTILITY CASE SERIES- micro TESE in Azoos***mia
The diagnosis of azoos***mia indicates that no s***m is identified in the centrifuged pellet of two separate semen samples.
Azoos***mia may be classified into obstructive azoos***mia (OA) and nonobstructive azoos***mia (NOA). NOA can be further divided into central NOA and testicular NOA. Generally, men with azoos***mia, normal size te**es, and normal serum follicle-stimulating hormone (FSH) levels have normal s***matogenesis and are more likely to have OA, while men with a significant elevation in FSH have testicular failure, and thus testicular NOA. Low levels of gonadotropins and low or low-normal testosterone suggest a central NOA diagnosis. The etiological diagnosis is made based upon a detailed clinical history, physical exam, and endocrine evaluation, in addition to supplemental testing.
Infertile men, particularly those with NOA, have higher percentages of s***m aneuploidy and DNA fragmentation due to abnormal s***matogenesis. Therefore, couples with NOA frequently face IVF failures, including poor fertilization, reduced implantation or increased miscarriage rates.
This couple was diagnosed as male factor infertility (azoos***mia) and FNAC of te**is revealed maturation arrest and hence suggested Donor s***m outside . Evaluation reveals NOA with high FSH 38 IU/ml, Karyotype was normal and YCMD reveals no microdeletions. As they want their biological child only, we discussed option of micro-TESE with probability of nil s***m retrieval. (Increased FSH and smaller testicular volume do not always provide an adverse prognosis for s***m retrieval, since they are not affected by a limited site of s***m production)
We proceed for micro-TESE and luckily found few non motile s***ms after finding possible focal areas of s***m production within the te**is by magnification using operating microscope. ICSI was performed and following transfer of 2 Blastocysts , healthy twin delivered .
Micro-TESE has become mainstay in the management of the man with NOA over conventional TESA particularly with high FSH . Consult with your fertility physician to discuss its pros and cons and success rate.
***mia ***mcount
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