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MESA, TESE, MicroTESE
1. MESA, TESE, MicroTESE
Sandro C. Esteves
Diretor Médico e Científico, ANDROFERT
Campinas, São Paulo
XXXV Congresso Brasileiro de Urologia
Rio de Janeiro, Novembro 2015 – C37
2. Técnicas de Captação de
Espermatozoides para
Reprodução Assistida (ICSI)
Esteves et al. Sperm Retrieval Techniques. Int Braz J Urol 2011; 37: 570-83
Acrônimo Técnica
MESA
Microsurgical Epididymal Sperm
Aspiration
TESE Testicular Sperm Extraction
Micro-TESE
Microdissection Testicular Sperm
Extraction
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 2
2015
ANDROFERT
3. Azoospermia Obstrutiva
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, 3
2015
ANDROFERT
4.
5. Microsurgical Epididymal Sperm
Aspiration (MESA)
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 5
2015
ANDROFERT
Cortesia Dr. Marcello Cocuzza
6. Esteves SC, Int Braz J Urol 2015; 41:817-8.
Available at:
www.brazjurol.com.br/videos/july_august_2015/Esteves_817_818video.htm
7. MESA vs PESA
MESA PESA
Efetividade (Sptz +) ~100% ~100%
Eficiência (No.
Sptz)
+++ ++
Criopreservação ~100% casos 1/3 casos
Custo-efetividade NA NA
Complexidade +++ +
Complicações ++ + (8/146=5.5%)*
Repetição Sim Sim
Efetividade ICSI ~40% NV/TEMiyaoka & Esteves. Clinics 2013; 68 Suppl 1: 111-9.
*Esteves et al. J Urol. 2013; 189(1): 232-7
8. 100% 96.6% 96.3%
CBAVD Vasectomy Post-infection
OBSTRUCTIVEAZOOSPERMIA
Successful Retrievals
PESA + rescue TESA
PESA alone
Esteves et al. J Urol. 2013; 189(1): 232-7
146 patients
Sperm retrieval in CBAVD
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 8
2015
ANDROFERT
78.1%
~100%
9.
10. Azoospermia Não-obstrutiva
Técnica Acrônimo Tx sucesso
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
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 10
2015
ANDROFERT
11.
12.
13. Micro-TESE vs TESE: Efetividade
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, 13
2015
ANDROFERT
14. Tissue removed (mg)
Conventional TESE Micro-TESE P-value
65 ± 25 8.9 ± 2.5 <0.01
Conventional TESE Micro-TESE
Esteves & Varghese J Reprod Sci 2012; 5: 233-43.
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 14
2015
ANDROFERT
Micro-TESE vs TESE: Eficiência
15. 41.4 47 43.3
20
100
64 61
34.2
Sperm
retrieval (%)
2PN
Fertilization
(%)
Top Quality
Embryos (%)
Live Birth (%)
Non-obstructive (N=365) Obstructive (N=146)
P<0.01
ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION
S ESTEVES, 15
2015
ANDROFERT
Certain cases of OA are potentially reversible by using microsurgical or endoscopic methods. Another option for this group of patients is ART. Sperm can be easily obtained from the epididymis or testicles by percutaneous or microsurgical methods.
Sperm can be easily obtained from the epididymis or testicles by percutaneous or microsurgical methods.
14
The chances of finding sperm, and the chances of achieving a live birth by ICSI is completely different depending on the type of azoospermia.
Successful sperm retrieval are 43 times higher in man with OA compared to NOA. Although men with NOA should not be considered sterile, their chances of having their own offspring is significantly lower compared to the counterpart with NOA