Andrology  Workshop  PESA/MESA/TESA/Micro-­‐TESE  

ISO 9001:2008

4th International Congress - Academy of Clinical Embryologists 18-20 September 2015, Kochi INDIA

Sandro C. Esteves, MD., PhD. Medical & Scientific Director, ANDROFERT

Andrology & Human Reproduction Clinic Campinas, BRAZIL

Obstructive Azoospermia

Technique Acronym

Percutaneous Epididymal Sperm Aspiration PESA

Microsurgical Epididymal Sperm Aspiration MESA

Testicular Sperm Aspiration TESA

Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2015

ANDROFERT

100% 96.6% 96.3%

CBAVD Vasectomy Post-­‐infection

OBSTRUCTIVE  AZOOSPERMIA

78.1 %

97.3%

Successful Retrievals

PESA + rescue TESA PESA alone

Esteves et al. J Urol. 2013

146 patients

Sperm retrieval in CBAVD

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 3 2015

ANDROFERT

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 4 2015

ANDROFERT

Esteves SC, Int Braz J Urol 2015; 41:817-8.

Available at: www.brazjurol.com.br/videos/july_august_2015/Esteves_817_818video.htm

Microsurgical Epididymal Sperm Aspiration (MESA)

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2015

ANDROFERT

Video MESA

http://androfert.com.br/videos

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 6 2015

ANDROFERT

Video TESA

Nonobstructive Azoospermia Technique Acronym Success

Testicular Sperm Aspiration

TESA 15-50%

Testicular Sperm Extraction

TESE 20-60%

Microsurgical Testicular Sperm Extraction

Micro-TESE 40-67%

Esteves & Agarwal. Sperm Retrieval Techniques. Cambridge University Press, 2011

TESE

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 7 2015

ANDROFERT

Micro-TESE more effective than conventional TESE in NOA

45%

93%

64%

20% 25%

64%

9% 6%

Overall Hypospermatogenesis Maturation Arrest Sertoli-cell Only

Sperm Retrieval Success Rates

Micro-TESE single-biopsy TESE

Controlled series (N=60)

Histology categories pairwise comparisons:

p<0.0001

Method P=0.0005

Verza Jr & Esteves. Fertil Steril 2011; 96 (Suppl.): S53

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2015

ANDROFERT

Tissue removed (mg) Conventional TESE Micro-TESE P-value

65 ± 25 8.9 ± 2.5 <0.01 Conven&onal  TESE   Micro-­‐TESE  

Verza Jr & Esteves Fertil Steril 2011; Esteves & Varghese J Reprod Sci 2013

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 9 2015

ANDROFERT

Micro-TESE more efficient than conventional TESE in NOA

Esteves SC, Int Braz J Urol 2013; 39:440.

ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 10 2015

ANDROFERT

Available at: www.brazjurol.com.br/videos/may_june_2013/Esteves_440_441video.htm

•  Video Micro-TESE

Thank you

This presentation is available at http://www.slideshare.net/

sandroesteves

4th International Congress - Academy of Clinical Embryologists 18-20 September 2015, Kochi INDIA