An ultrasonically actuated silicon-microprobe-based testicular tubule assay.

Microdissection testicular sperm extraction (TESE) is an invasive surgical procedure in which sparsely located healthy larger diameter tubules carrying viable spermatazoa are identified by visual examination of the seminiferous tubules of the infertile testis under a microscope, and biopsies of regions of interest are performed. In this paper, we report on microfabricated silicon microprobes integrated with an ultrasonic horn actuator and strain gauges for microdissection probe-TESE (MP-TESE) surgery. The microprobes, with axial-force-sensitive polysilicon strain gauges, have high force sensitivity (-0.4 V/N). The probes were used to detect the boundaries between seminiferous tubules, thus enabling identification of individual tubule diameters. Insertion experiments were performed on rat testis tissue, and by monitoring the tubule puncture in the recorded force, we were able to estimate the average diameter approximately 41.2 +/- 1.6 microm of the sperm-carrying tubules in samples. We have also demonstrated the ability to sense the existence of larger tubules embedded in a mess of thinner tubules, using an analytically calculated expression for the distribution of sizes measured by the microprobe. This information is important in MP-TESE to distinguish tubules with and without fertile sperm, potentially eliminating the large incision currently required for optical spermatazoa localization.

Microsurgical single tubular epididymovasostomy: assessment in the era of intracytoplasmic sperm injection.

OBJECTIVE: To reevaluate the role of microsurgical single tubular epididymovasostomy for the treatment of obstructive azoospermia in the era of intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective clinical study. SETTING: University infertility clinic. PATIENT(S): Sixty-one patients with obstructive azoospermia who underwent microsurgical single tubular epididymovasostomy. INTERVENTION(S): Microsurgical single tubular epididymovasostomy. MAIN OUTCOME MEASURE(S): The overall patency and live-birth rates and factors that influenced the surgical outcome. RESULT(S): The overall patency rate after surgery was 68.9% (42/61) and the live-birth rate 31.1% (19/61). Of the 19 live-birth cases, 11 were achieved by natural means and 2 were achieved by conventional IVF soon after the operation, then subsequently by natural conception. The remaining 6 were the result of conventional IVF after surgery. An analysis of the potential prognostic factors previously associated with epididymovasostomy indicated that none had a statistically significant correlation with surgical outcome. In cases of patency, the partners were stratified into a younger group (21-30 years; n = 12) and an older group (31-36 years; n = 30). There was no statistically significant difference between the groups in the live-birth rate regardless of the means of conception (natural versus conventional IVF). CONCLUSION(S): This study demonstrates that the results obtained by microsurgical single tubular epididymovasostomy are comparable to those obtained with the use of IVF and ICSI. Even in this era of ICSI, the option of microsurgical single tubular epididymovasostomy should be considered because ICSI involves surgery to retrieve sperm and complex invasive treatment of the wife.