Login to Access Video or Poster Abstract: MP89-08
Sources of Funding: none

Introduction

Ultrasonographically guided puncture (UGUP) of the rete testis (RT) has been proven to be an efficient method for sperm recovery in obstructed azoospermic men (Andrologia 35:85, 2003). In the current study we evaluated the role of UGUP of the RT in sperm recovery from non-obstructed azoospermic (NOA) men.

Methods

Bilateral UGUP of the RT was performed in 83 NOA-men. Under local anesthesia and ultrasonographical control (mode B, frequency of 7.50 MHz), the hyperdense tip of a 30-gauge needle approached and reached the RT of each NOA-man. When ultrasonographical control demonstrated that the tip of the needle had reached the hyperdense line of the RT negative pressure was applied and cells from the RT were aspirated. All the aspirated samples from the RT were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization (FISH) techniques. Men who were negative for spermatozoa after UGUP of the RT underwent microsurgical therapeutic testicular biopsy (MTTB). Recovered spermatozoa subpopulations either from UGUP-RT samples or from MTTB-samples were frozen.

Results

UGUP of the RT resulted in sperm recovery in 19 men (22.89%). The remaining 64 NOA-men underwent MTTB. Twenty nine men out of the 64 men (45.31%) who underwent MTTB demonstrated testicular spermatozoa. Thus in total, 48 men (57.83%) were positive for spermatozoa either in the UGUP-RT-samples or in the MTTB-samples. There was not a significant difference between the mean value of peripheral serum testosterone three months after UGUP-RT and the respective mean value prior to UGUP-RT. FISH techniques in UGUP-RT samples demonstrated in each of the 19 men at least 81% haploid spermatozoa. Hematomas were not demonstrated by ultrasonography one, three, and nine weeks post-UGUP-RT. Nine couples from the above mentioned 19 NOA-couples participated in assisted reproductive technology programs. Three clinical pregnancies were achieved. Four offspring were delivered.

Conclusions

Considering that UGUP-RT puncture a) does not reduce the volume of testicular parenchyma, b) is less invasive than MTTB, and c) apparently causes less detrimental effect on testicular vasculature than MTTB, UGUP-RT is recommended as first line approach for the treatment of NOA-men. If UGUP-RT is negative for spermatozoa in non-obstructed men, biopsy is indicated.

Funding

none