Original Title: [Effektivitet och säkerhet av mikrokirurgisk testikelspermaextraktion hos infertila män med icke-obstruktiv azoospermi]

Authors' objectives: Background Azoospermia, absence of sperm in the ejaculate, affects approximately 1% of the male population. About 40 men with infertility are referred to the Reproductive medicine department at Sahlgrenska University Hospital in Gothenburg annually. Testicular Sperm Aspiration (TESA, needle punction) or Percutaneous Epididymal Sperm Aspiration (PESA) are used to find spermatozoa and categorises azoospermia patients into obstructive or non-obstructive azoospermia (NOA). TESA is a blind method and failure to retrieve spermatozoa is common. With testicular sperm extraction (TESE), multiple blind surgical biopsies are taken from the testicles. TESA and TESE results are comparable concerning sperm retrieval rate, clinical pregnancy rate and live birth rate. TESA is the currently used technique in our hospital. A recent technique, micro-TESE, allows a more extensive search for spermatozoa. Under an operation microscope, the tunica albuginea is widely opened and small testicular tissue samples are excised and immediately examined for spermatozoa under a microscope. If needed, further samples are taken from the ipsi- and contralateral testicles. Questions at issue Is micro-surgical TESE, compared with TESA, in men with non-obstructive azoospermia safe and effective regarding sperm retrieval, clinical pregnancy and live birth rates? Is micro-TESE sufficiently effective and safe after a failed TESA?

Authors' results and conclusions: One cohort study comparing micro-TESE with TESA and 19 case series were identified. Sperm retrieval rate may be higher with micro-TESE compared with TESA (GRADE ⊕⊕ ) and the pooled sperm retrieval rate of the case series was 45% (95% CI 39% to 51%). Clinical pregnancy and live birth rates (95% CI) of micro-TESE were 15 to 25% and 9 to 20% respectively. Complications, mainly minor, ranged 0-9%. In summary, micro-TESE may improve sperm retrieval in men with NOA and is associated with few severe complications. There is a need of large high quality studies comparing results of micro-TESE with TESA.

Project Status: Completed

Year Published: 2019

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-343/native/2019_108%20HTA-rapport%20m%20TESE.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se