problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl201359547-60problendo-6490Research ArticleСтатьиArticlesСовременные подходы к лечению азооспермии методом микро-ТЕСЕ в программе ЭКО/ИКСИ. Обзор литературы. Часть IIThe role of modern technologies in the management of azoospermia using micro-TESE in the framework of the ECF/ICSI program. A literature review. Part II.VitiazevaI Ivitiazeva@yandex.ruBogoliubovS V-DedovI I-201315102013595ТОМ 59, №5 (2013)4760Copyright © Vitiazeva I.I., Bogoliubov S.V., Dedov I.I., 20132013Vitiazeva I.I., Bogoliubov S.V., Dedov I.I.Vitiazeva I.I., Bogoliubov S.V., Dedov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/6490

Во второй части обзора, посвященного лечению азооспермии методом микро-ТЕСЕ в программе ЭКО/ИКСИ, рассматриваются вопросы гормональной подготовки пациентов с необструктивной азооспермией (НОА) препаратами ГнРГ, хорионическим и менопаузальными гонадотропинами. Эффективность извлечения сперматозоидов возрастает после использования стимуляции сперматогенеза в течение 6 мес и более. Оценка дополнительных гормональных факторов, таких как ФСГ, АМГ, ингибин-В в сыворотке и семенной плазме, позволяют более точно прогнозировать исход микро-ТЕСЕ. Высокий уровень ФСГ не является противопоказанием для микрохирургического извлечения сперматозоидов у мужчин с НОА. Ни уровень ФСГ, ни объем яичек не связаны с результативностью операции. Молекулярно-генетические маркеры остаточного сперматогенеза - гены ESX1, VASA, CLU могут служить предикторами успешного извлечения сперматозоидов при микро-ТЕСЕ у пациентов с НОА. Рассмотрены преимущества методики микродиссекции, техника выполнения операции, включая эмбриологический этап выделения сперматозоидов из тестикулярной ткани, результативность микро-ТЕСЕ в зависимости от патоморфологической картины и осложнения после операции.

In the second part of the review, devoted to treatment of azoospermia by micro-TESE in program IVF/ICSI, there were considered issues of hormonal preparation of patients with non-obstructive azoospermia (NOA) prior to the course of GnRH, chorionic and menopausal gonadotropin treatment. Sperm retrieval efficiency increases after stimulation of spermatogenesis 6 months. Identification of additional factors such as FSH, AMH, and Inhibin B in blood serum and seminal plasma can provide more accurate prognosis of the outcome of micro-TESE. High level of FSH is not a contraindication for microsurgical sperm retrieval in men with NOA. Neither level of FSH nor testicular volume is related to the effectiveness of operation. Molecular genetic markers of residual spermatogenesis (ESX1, VASA and CLU genes) can serve as predictors of successful sperm retrieval during micro-TESE in patients with NOA. In the review there were also considered advantages of microdissection technique, technique of operation performance (including embryological stage of detection of spermatozoa in testicular tissue), and efficiency of micro-TESE depending on pathological patterns and complications after surgery.

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The authors declare that there are no conflicts of interest present.