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    Sperm extraction: MicroTESE and multiphoton microscopy


    Philip S. Li, MDPhilip S. Li, MD Ranjith Ramasamy, MDRanjith Ramasamy, MD Craig S. Niederberger, MDCommentary by Craig S. Niederberger, MD

    Dr. Li is is associate research professor of urology and reproductive medicine and director of the male infertility microsurgical research and training program at the Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medical College, New York. Dr. Ramasamy, a former Weill Cornell urology resident, is director of male reproductive medicine and surgery and assistant professor of urology at the University of Miami.


    Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. In this installment, two expert infertility groups demonstrate approaches for obtaining sperm in men with azoospermia. 

    Male infertility can be secondary to azoospermia (lack of sperm in the ejaculate) secondary to testicular failure. Sperm retrieval in combination with intracytoplasmic sperm injection (ICSI) offers a chance of fathering a biological child. The video reviews microdissection testicular sperm extraction (microTESE) as well as multiphoton microscopy, a novel tool that can aid in identification of sperm within the testis. 

    Dr. Niederberger: Microsurgical testis sperm extraction is now a leading technique in harvesting sperm and confers many advantages. Challenges remain in improving yields, as a visually identified fat tubule may not necessarily bear sperm. In this video, the investigators demonstrate a promising technique using multiphoton microscopy to find tubules containing sperm during microsurgical testis sperm extraction. Should it be demonstrated safe and effective, it may be a significant step in the hunt to track down the ever-elusive testicular sperm.

    Dr. Hotaling: The Weill Cornell team demonstrates a novel approach to optimize chances of obtaining sperm in men with spermatogenic failure through microTESE. Dr. Schlegel, who pioneered this technique in 1999 and has the largest case series of microTESE cases, demonstrates meticulous tissue handling, operating in a bloodless field to optimize visual identification of dilated tubules that are more likely to contain mature sperm. The video then goes on to demonstrate an animal model of spermatogenic failure and the use of multiphoton microscopy to identify tubules containing sperm and, importantly, shows that this technique does not harm the sperm. Improvement of identification of sperm in microTESE would represent a major advancement in this technique and would allow more men with spermatogenic failure to have biologic children. We look forward to further work demonstrating the efficacy of this technique in humans. 


    Also watch - Sperm extraction: Two percutaneous techniques

    James M. Hotaling, MD, MSJames M. Hotaling, MD, MS, Section Editor

    Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah Health Care, Salt Lake City.

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