ClinicalTrials.gg
CompletedNCT06702397Updated Nov 25, 2024

TeSE (Testicular Sperm Extraction) in Azoospermic Patients: m-TeSE vs. l-TeSE

An interventional study of Microscope and Surgical loupes in Azoospermia, Nonobstructive, sponsored by A.O.U. Città della Salute e della Scienza. Completed at 1 site in Italy. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-11-25.

Sponsored by A.O.U. Città della Salute e della Scienza · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Registered 2 years 8 months after the study started (first participant enrolled Mar 2022, registered Nov 2024).
Phase
Not applicable
Study type
Interventional
Enrollment
42
Allocation
Randomized
Ages
18 Years and older
Sex
Male
01

Study summary

The aim of the study is to compare surgical outcomes (intra and post-operative complications) and sperm retrieval rates between conventional microsurgical-assisted testicular sperm extraction (m-TeSE - Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE - Group B) in adult males with non-obstructive azoospermia.

Read the detailed description

Objective: To compare surgical outcomes and sperm retrieval rates (SRR) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE - Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE - Group B) in adult males with non-obstructive azoospermia (NOA). A multicentric prospective randomized trial was conducted from March 2022. Adult males with NOA without genetic alterations who agreed to participate in the study and signed the required informed consent were enrolled. SRR, intra and post-operative complications (according to Clavien-Dindo classification), hormonal profile tchanges were considered as outcomes during the follow up period.

02

Conditions studied

  • Azoospermia, Nonobstructive
03

In context

Azoospermia, Nonobstructive

23 studies on the registry are indexed under Azoospermia, Nonobstructive; 7 are open to participants now.

This study's enrollment of 42 is below the median of 61 across 12 interventional studies indexed under Azoospermia, Nonobstructive.

Browse Azoospermia, Nonobstructive studies →

Lead sponsor

A.O.U. Città della Salute e della Scienza is the lead sponsor of 65 studies on the registry; 13 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Male
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Adult males
  • Diagnosis of non obstructive azoospermia who required m-TeSE.

Exclusion criteria

Exclusion Criteria:

  • Absence of signed written
  • Age \< 18 years
  • Obstructive azoospermia
  • Genetic anomalies (e.g., Klinefelter syndrome, Kallmann syndrome, Y chromosome microdeletions, CFTR mutations)
  • Previous testicular /surgical sperm retrieval
  • Personal history of malignant testicular tumor
  • Unilateral cryptorchidism
  • Varicocele
  • Previous chemotherapy/radiotherapy treatments
  • Monorchidism
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
42 participants (actual)

Study arms

  • Active comparator
    Microsurgical-assisted testicular sperm extraction (m-TeSE) - Group A

    A longitudinal incision of 3cm was made along the scrotal raphe using a scalpel. Surgical dissection proceeded layer by layer. The testis was separated from the surrounding dartos and luxated outside the scrotal sac. A longitudinal incision was made in the tunica vaginalis to allow complete exposure of the tunica albuginea. Two Vicryl 2-0 traction sutures were placed 0.5 cm cranially and caudally to the testicular equatorial line, which was subsequently incised with a scalpel for 3/4 of the testicular circumference. In M-TESE, through the operating microscope, a direct examination of the testicular parenchyma was performed under magnification (20-25x). Multiple testicular specimens were excised. The same procedure is performed on the contralateral side, where instead of the operating microscope, the surgeon uses surgical loupes for magnification (3.5 - 5x).

    Device: Microscope

  • Active comparator
    Testicular sperm extraction performed with surgical loupes (l-TeSE) - Group B

    A longitudinal incision of 3cm was made along the scrotal raphe using a scalpel. Surgical dissection proceeded layer by layer. The testis was separated from the surrounding dartos and luxated outside the scrotal sac. A longitudinal incision was made in the tunica vaginalis to allow complete exposure of the tunica albuginea. Two Vicryl 2-0 traction sutures were placed 0.5 cm cranially and caudally to the testicular equatorial line, which was subsequently incised with a scalpel for 3/4 of the testicular circumference. In M-TESE, through the operating microscope, a direct examination of the testicular parenchyma was performed under magnification (20-25x). Multiple testicular specimens were excised. The same procedure is performed on the contralateral side, where instead of the operating microscope, the surgeon uses surgical loupes for magnification (3.5 - 5x).

    Device: Surgical loupes

Interventions

  • DeviceMicroscope

    The microscope provides a direct examination of the testicular parenchyma at 20-25x magnification.

  • DeviceSurgical loupes

    Surgical loupes offer magnification of 3.5-5x.

06

What researchers measure

Primary outcomes

  1. Positive sperm retrieval

    Number of sperm retrieval

    Time frame: immediately after the surgery

  2. Histology

    Normal testicular biopsy or Hypospermatogenesis or Germ cell arrest or Sertoli cell-only syndrome or Seminiferous tubule hyalinization or CIS or Immature testis

    Time frame: immediately after the surgery

  3. Johnsen score

    Number according to Johnsen score

    Time frame: immediately after the surgery

  4. Sperm vials stored

    Number

    Time frame: immediately after the surgery

Secondary outcomes

  1. Operative time

    Minutes

    Time frame: immediately after the surgery

  2. Complications

    Clavien dindo classification

    Time frame: through study completion, an average of 1 year

07

Study locations

1 site
  • Molinette - AOU Città della Salute e della Scienza di Torino
    Turin, 10126, Italy
08

References and documents

Publications

  • Chen ML, Buncke GM, Turek PJ. Narrative review of the history of microsurgery in urological practice. Transl Androl Urol. 2021 Apr;10(4):1780-1791. doi: 10.21037/tau-20-1441. PubMed 33968665 ↗
  • Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015 Nov;104(5):1099-103.e1-3. doi: 10.1016/j.fertnstert.2015.07.1136. Epub 2015 Aug 8. PubMed 26263080 ↗
  • Flannigan R, Bach PV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol. 2017 Aug;6(4):745-752. doi: 10.21037/tau.2017.07.07. PubMed 28904907 ↗
  • Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ, Wang SG, Liu JH, Wang T. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl. 2018 Jan-Feb;20(1):30-36. doi: 10.4103/aja.aja_5_17. PubMed 28361811 ↗
  • Pozzi E, Raffo M, Negri F, Boeri L, Sacca A, Belladelli F, Cilio S, Ventimiglia E, d'Arma A, Pagliardini L, Vigano P, Pontillo M, Luciano R, Colecchia M, Montorsi F, Alfano M, Salonia A. Anti-Mullerian hormone predicts positive sperm retrieval in men with idiopathic non-obstructive azoospermia-findings from a multi-centric cross-sectional study. Hum Reprod. 2023 Aug 1;38(8):1464-1472. doi: 10.1093/humrep/dead125. PubMed 37322566 ↗
  • Tournaye H, Liu J, Nagy PZ, Camus M, Goossens A, Silber S, Van Steirteghem AC, Devroey P. Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod. 1996 Jan;11(1):127-32. doi: 10.1093/oxfordjournals.humrep.a019004. PubMed 8671174 ↗
  • Boeri L, Palmisano F, Preto M, Sibona M, Capogrosso P, Franceschelli A, Ruiz-Castane E, Sarquella-Geli J, Bassas-Arnau L, Scroppo FI, Sacca A, Gentile G, Falcone M, Timpano M, Ceruti C, Gadda F, Trost L, Colombo F, Rolle L, Gontero P, Montorsi F, Sanchez-Curbelo J, Salonia A, Montanari E. Sperm retrieval rates in non-mosaic Klinefelter patients undergoing testicular sperm extraction: What expectations do we have in the real-life setting? Andrology. 2020 May;8(3):680-687. doi: 10.1111/andr.12767. Epub 2020 Feb 16. PubMed 31999885 ↗
  • Ostad M, Liotta D, Ye Z, Schlegel PN. Testicular sperm extraction for nonobstructive azoospermia: results of a multibiopsy approach with optimized tissue dispersion. Urology. 1998 Oct;52(4):692-6. doi: 10.1016/s0090-4295(98)00322-7. PubMed 9763095 ↗
  • Pozzi E, Boeri L, Capogrosso P, Palmisano F, Preto M, Sibona M, Franceschelli A, Ruiz-Castane E, Sarquella-Geli J, Bassas-Arnau L, Scroppo FI, Gentile G, Falcone M, Timpano M, Ceruti C, Gadda F, Colombo F, Rolle L, Gontero P, Montorsi F, Sanchez-Curbelo J, Montanari E, Salonia A. Rates of hypogonadism forms in Klinefelter patients undergoing testicular sperm extraction: A multicenter cross-sectional study. Andrology. 2020 Nov;8(6):1705-1711. doi: 10.1111/andr.12843. Epub 2020 Jul 3. PubMed 32558292 ↗
  • Vieira M, Bispo de Andrade MA, Santana-Santos E. Is testicular microdissection the only way to retrieve sperm for non-obstructive azoospermic men? Front Reprod Health. 2022 Aug 23;4:980824. doi: 10.3389/frph.2022.980824. eCollection 2022. PubMed 36303631 ↗
  • Serletti JM, Deuber MA, Guidera PM, Reading G, Herrera HR, Reale VF, Wray RC Jr, Bakamjian VY. Comparison of the operating microscope and loupes for free microvascular tissue transfer. Plast Reconstr Surg. 1995 Feb;95(2):270-6. doi: 10.1097/00006534-199502000-00006. PubMed 7824606 ↗
  • Boeri L, Bebi C, Dente D, Greco E, Turetti M, Capece M, Cocci A, Cito G, Preto M, Pescatori E, Ciampaglia W, Scroppo FI, Falcone M, Ceruti C, Gadda F, Franco G, Deho F, Palmieri A, Rolle L, Gontero P, Montorsi F, Montanari E, Salonia A. Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed classic TESE: results from a multicenter cross-sectional study. Int J Impot Res. 2022 Dec;34(8):795-799. doi: 10.1038/s41443-021-00487-8. Epub 2021 Nov 6. PubMed 34743195 ↗
  • Falcone M, Boeri L, Timpano M, Cirigliano L, Preto M, Russo GI, Peretti F, Ferro I, Plamadeala N, Gontero P. Combined Trifocal and Microsurgical Testicular Sperm Extraction Enhances Sperm Retrieval Rate in Low-Chance Retrieval Non-Obstructive Azoospermia. J Clin Med. 2022 Jul 13;11(14):4058. doi: 10.3390/jcm11144058. PubMed 35887821 ↗
  • Schlegel PN, Su LM. Physiological consequences of testicular sperm extraction. Hum Reprod. 1997 Aug;12(8):1688-92. doi: 10.1093/humrep/12.8.1688. PubMed 9308794 ↗
  • Schoysman R, Vanderzwalmen P, Nijs M, Segal L, Segal-Bertin G, Geerts L, van Roosendaal E, Schoysman D. Pregnancy after fertilisation with human testicular spermatozoa. Lancet. 1993 Nov 13;342(8881):1237. doi: 10.1016/0140-6736(93)92217-h. No abstract available. PubMed 7901551 ↗
  • Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992 Jul 4;340(8810):17-8. doi: 10.1016/0140-6736(92)92425-f. PubMed 1351601 ↗
  • Zhao H, Xu J, Zhang H, Sun J, Sun Y, Wang Z, Liu J, Ding Q, Lu S, Shi R, You L, Qin Y, Zhao X, Lin X, Li X, Feng J, Wang L, Trent JM, Xu C, Gao Y, Zhang B, Gao X, Hu J, Chen H, Li G, Zhao J, Zou S, Jiang H, Hao C, Zhao Y, Ma J, Zheng SL, Chen ZJ. A genome-wide association study reveals that variants within the HLA region are associated with risk for nonobstructive azoospermia. Am J Hum Genet. 2012 May 4;90(5):900-6. doi: 10.1016/j.ajhg.2012.04.001. Epub 2012 Apr 26. PubMed 22541561 ↗
  • Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol. 1989 Jul;142(1):62-5. doi: 10.1016/s0022-5347(17)38662-7. PubMed 2499695 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Mar 2022 to primary completion in Apr 2024, 25 months.

How these figures are worked out, and which studies are left out of them.

Registered
Nov 3, 2024
First posted
Nov 25, 2024
StartActual
Mar 1, 2022
Primary completionActual
Apr 30, 2024
CompletionActual
Apr 30, 2024
Last update
Nov 25, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Nov 25, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06702397
Lead sponsor
A.O.U. Città della Salute e della Scienza
Collaborators
Federica Peretti, Ilaria Ferro, Natalia Plamadeala, Martina Scavone, Luca Boeri, Marco Falcone, Lorenzo Cirigliano, Valentina Parolin, Emanuele Zupo, Paolo Gontero
Responsible party
Mirko Preto (Doctor Mirko Preto, A.O.U. Città della Salute e della Scienza) — Principal investigator
First posted
Nov 25, 2024
Start date
Mar 1, 2022
Primary completion
Apr 30, 2024
Completion
Apr 30, 2024
Last update
Nov 25, 2024

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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