New urology procedure provides hope for male infertility

A revolutionary treatment for men otherwise unable to conceive that was pioneered at the Cornell School of Medicine has been performed for the first time by urologists at the Henry Ford Hospital in Detroit, Michigan in the US.

Categorized as a microsurgery, the procedure involves the surgical harvesting of sperm cells from a patient whose choices would otherwise be limited to using donor sperm or adopting children, according to Ali Dabaja, M.D., director of reproductive medicine and sexual medicine at Henry Ford Health System.

Candidates for the operation are those whose semen contains very few or even no sperm cells, a condition called non-obstructive azoospermia, which affects about one percent of the male population and 10 percent of those seeking fertility treatment.

"Until recently, it was assumed that men with non-obstructive azoospermia were untreatable," says Dr. Dabaja. "Indeed, these patients were often referred to as being 'sterile' or having 'testicular failure.'"

While these men may have little to no sperm in their ejaculate, advances in fertility medicine indicate that sperm often hide in their testicles, according to Dr. Dabaja.

"Even so, it was previously thought that sperm must travel through the male reproductive tract before acquiring the ability to normally fertilize an egg," he says.

The ensuing procedure helped change that view, according to Dr. Dabaja, who describes intracytoplasmic sperm injection (ICSI) as injecting the sperm cell directly into the egg using a tiny needle.

The refined biopsy developed by Dr. Dabaja and his team is called microdissection testicular sperm extraction, or micro-TESE for short, and the amount of testicular tissue removed is minimal by comparison to other biopsy procedures.

"It requires the use of an operating microscope to assist in the biopsy by identifying which tubules in the testicle are producing sperm cells," Dr. Dabaja says. "This allows us to remove tiny samples of testicular tissue with improved sperm yield."

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