Harvard Medical School, Boston, MA, USA.
Division of Urology, Brigham and Women's Hospital, Boston, MA, USA.
Andrology. 2021 Jul;9(4):1108-1118. doi: 10.1111/andr.12997. Epub 2021 Mar 15.
Publications of microsurgical testicular sperm extraction (mTESE) techniques and outcomes are heterogeneous, which may limit creation of best surgical practices.
To study the quality and heterogeneity of published mTESE outcomes via a methodological analysis.
MATERIALS/METHODS: A systematic methodological analysis of all published literature on the use of mTESE in men with non-obstructive azoospermia from 1999 to the July 2020 was performed. PubMed and MEDLINE searches were performed using the search terms "microdissection TESE OR microsurgical TESE." Publications were evaluated on their reporting of pre-operative factors, intraoperative techniques, surgical and clinical outcomes, and adverse events.
Fifty-five studies met inclusion criteria. Surgical technique and sperm retrieval rates were the most reported criteria. Reporting on the presence of an embryologist intraoperatively was observed in approximately 30% of articles, while other procedural details including method of sperm quantification, quantity retrieved, and number of cryopreserved vials were observed in fewer than 10% of articles. Clinical outcomes, including pregnancy rates and live birth rates, were reported in fewer than 40% of the articles. Fetal outcomes including fetal and neonatal anomalies were rarely reported. Fetal growth restriction, preterm delivery, small or large for gestational age, and NICU admissions were never reported.
There are inconsistencies in reporting quality of mTESE outcomes, specifically a lack of information on the quantity and quality of sperm retrieved, the role of embryology intraoperatively, and clinical outcomes, such as live birth rate and fetal anomalies. These gaps may guide development of standardized reporting guidelines to better assess and compare clinical outcomes across institutions and maintain focus on couples-centric fertility outcomes in future mTESE studies.
发表的显微睾丸精子提取（mTESE）技术和结果存在异质性，这可能限制了最佳手术实践的制定。
通过方法学分析研究发表的 mTESE 结果的质量和异质性。
材料/方法：对 1999 年至 2020 年 7 月发表的所有关于非梗阻性无精子症男性使用 mTESE 的文献进行了系统的方法学分析。使用“显微解剖 TESE 或显微外科 TESE”的检索词在 PubMed 和 MEDLINE 上进行了检索。对术前因素、术中技术、手术和临床结果以及不良事件的报告情况对出版物进行了评估。
55 项研究符合纳入标准。手术技术和精子获取率是报告最多的标准。约 30%的文章报道了术中是否有胚胎学家，而其他程序细节，包括精子定量方法、获取的精子数量和冷冻保存管的数量，在不到 10%的文章中报道。包括妊娠率和活产率在内的临床结果，在不到 40%的文章中报告。胎儿结局，包括胎儿和新生儿畸形，很少被报道。胎儿生长受限、早产、小于胎龄或大于胎龄儿以及新生儿重症监护病房入院从未被报道过。
mTESE 结果的报告质量存在不一致性，特别是缺乏有关精子获取的数量和质量、术中胚胎学的作用以及临床结果（如活产率和胎儿畸形）的信息。这些差距可能指导制定标准化的报告指南，以便更好地在机构之间评估和比较临床结果，并在未来的 mTESE 研究中关注以夫妇为中心的生育结果。
