RSNA 2005 

Abstract Archives of the RSNA, 2005


SSQ06-09

Controlled Tissue Perfusion-guided Biopsies are Essential for the Outcome of Testicular Sperm Extraction (TESE)

Scientific Papers

Presented on December 1, 2005
Presented as part of SSQ06: Genitourinary (Ultrasound)

Participants

Ferdinand Frauscher MD, Presenter: Nothing to Disclose
Leo Pallwein MD, Abstract Co-Author: Nothing to Disclose
Andrea Klauser MD, Abstract Co-Author: Nothing to Disclose
Georg Bartsch MD, Abstract Co-Author: Nothing to Disclose
Ralf Herwig MD, Abstract Co-Author: Nothing to Disclose
Dieter Zur Nedden MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Quality of sperm is essential for success of in vitro fertilisation (IVF). In order to determine if there are areas of major and minor perfusion in a single testicle and if the quality of sperm is correlated with quantity of perfusion, we collected testicle tissue for TESE in accordance to the local testicle tissue perfusion.

METHOD AND MATERIALS

Patients undergoing TESE for assisted reproduction (ICSI) underwent a preoperative testicular perfusion mapping using color Doppler Ultrasound. A needle was placed in the area of best perfusion and in a random area. After incision with radiofrequency cutting, the exposed tissue was additionally scanned with a Laser Doppler scanner and perfusion rates were determined measuring tissue perfusion units (TPU). Tissue was biopsied for TESE and Johnson score. Sperm were analysed according to WHO criteria and prepared for ICSI.

RESULTS

From 40 perfusion-controlled biopsies taken from 20 testicles of 12 patients, tissue preparations were analysed for sperm quality and quantity. Best sperm quality was found in areas of high TPU. In areas from 70 TPU 72.3% progressive sperm, whereas in areas of 10 TPU only few sperm (13.3%) and elevated numbers of precursor cells could be observed in these tissue preparations. The amount of motile sperm isolated from biopsied tissue correlated (R-square 0.89, p=0.0001) well with the intensity of tissue perfusion showing high number of sperm in areas with high TPU.

CONCLUSION

This is the first demonstration on patients suffering from azoospermia that sperm quality and quantity is depending on tissue perfusion within the testicle. Since the outcome of ICSI is strongly dependent on sperm quality, random biopsies should be replaced by perfusion-dependent collection of testicular tissue to further improve infertility treatment.

Cite This Abstract

Frauscher, F, Pallwein, L, Klauser, A, Bartsch, G, Herwig, R, Zur Nedden, D, Controlled Tissue Perfusion-guided Biopsies are Essential for the Outcome of Testicular Sperm Extraction (TESE).  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412556.html