guwahati tesa dr anand shinde

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Dr. Anand K Shinde MD (Gyn) Director Andrology @ ‘IVF-Pune’ Deenanath Mangeshkar Hospital Pune President Elect POGS (PUNE OBGYN SOCIETY ) Founder Member Indian Menopause Society Member Safe Motherhood Committe FOGSI Consultant & P.G. Teacher Dept OBGYN D.M.H

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  • 1. Dr. Anand K ShindeMD (Gyn) Director Andrology @ IVF-PuneDeenanath Mangeshkar Hospital Pune President Elect POGS (PUNE OBGYN SOCIETY ) Founder Member Indian Menopause Society Member Safe Motherhood Committe FOGSI Consultant & P.G. Teacher Dept OBGYN D.M.H

2. Welcome to S I G A SIGA - ANDROMEDA Greetings for 2010 ! Dr. Anand K ShindeMD (Gyn)Director AndrologyIVF-PuneDeenanath Mangeshkar HospitalPune - 411 004Cell - 09822012166, Tel. 020-40151777 3. Waist to Hip Ratio 4. The Soil, the Tree & the seeds ! 5. Diagnostic TESA What Do We Diagnose ?1. Presence of Sperm in Testis2. Histopathological picture to explain the Azoospermia3. Carcinoma In Situ (C.I.S.) Dr. Anand K Shinde 6. TESA TESA as a method toretrieve sperms inAzoospermia( For ICSI = Yes ! ) but...TESA as a method ofTesticular Biopsy ?Yes it is possible to getTesticular Biopsy by TESA !(Diagnostic use ? )Dr. Anand K Shinde 7. HPE Seminiferous Tubule (N) Dr. Anand K Shinde 8. HPE Spermatogenic arrestDr. Anand K Shinde 9. Mixed Phenotypes SCO + Normal Heterogenous TubulesHigh chance of success at TESE ShowingTesticularDamage 10. Sertoli Cell Only Syndrome SCOS as in Idiopathic infertility, Y Microdeletions, Orchitis, Chemo/Radiotherapy, Embryonal failure of Germ Cell migration to the GonadalRidge. TESE -25% successful..due to mixed variants 11. Klinefelters Syndrome can have Sperms !(E) The typical appearance of a biopsy from a man with Klinefelters syndrome isshown composed of seminiferous tubule hyalinization (arrows), aggregations of LCand occasional tubules with Sertoli cells only. This pattern is not diagnostic ofKlinefelters syndrome and can result from a range of pathological processes (10).(F) A biopsy from a man with Klinefelters syndrome illustrating a tubule showing fullspermatogenesis surrounded by aggregations of LC (25). All tissues are fixed in GRfixative, except F, which is fixed in Clelands fixative, and all are haematoxylineosin(HE) stained. R.I.McLachlan et al. 12. CIS 13. Immunocytological semen analysis for CIS PositiveNegativePositiveSemen Positive CIS Tubule 14. Indications of Tesicular Biopsy (in general are as follows)1. Detection of severity & type of Spermatogenic falilure A. Prognostic factor for subsequent ICSI B. Phenotyping in clinical research. Dr. Anand K Shinde 15. Indications of Tesicular Biopsy (in general are as follows)2. Differentiating Obstructive Azoospermia (OA)fromNon-obstructive Azzospermia (NOA) A. Equivocal Endocrine (FSH, inhibin B) B. Equivocal Clinial findings (TesticularVol.) C. Prior to reconstructive surgery for OA Dr. Anand K Shinde 16. Indications of Tesicular Biopsy(in general are as follows)3. Evaluation for Testicular Neoplasia / CISA. At Pubertal / Adult OrchiopexyB. For at Risk Population- NOA- H/O Cryptorchidism- Scrotal USG - Microlithiasis- In Ca Testis case for other sideDr. Anand K Shinde 17. Indications of Tesicular Biopsy(in general are as follows)4. Failure of prolonged Gonadotrophin therapy inHypogonadotrophic HypogonadismIf Testicular Biopsy for diagnosis(and subsequent Rx) is so important.. Is TESA the best way to do it ?Let us see .. Dr. Anand K Shinde 18. TESA Efficacy & EaseTESA : Sperms Recovery TESE : Sperms RecoveryOA100% 100%NOA Let us see ! Let us see !Dr. Anand K Shinde 19. TESA Efficacy StudyNo ofSpermSpermPMenRecovery byRecovery by TESE TESARosenlund et al(1998)21 gauge* 12 (17)50% (6) 16.7% (2)19 gauge* 10 (16)70% (7) 60% (6)Ezeh et al (1998) 35 63% (22)14% (5)