Microsurgical versus conventional single-biopsy testicular sperm extraction in nonobstructive azoospermia: a prospective controlled study

Abstract

To compare the success rates of sperm retrieval using either microsurgical testicular sperm extraction (micro-TESE) or conventional testicular sperm extraction (TESE) in a group of men with nonobstructive azoospermia (NOA). Prospective and controlled study. Sixty men with NOA were enrolled in this study and each patient served as his own control. For conventional TESE, two large (6x6x6 mm) biopsies of random testicular parenchyma were obtained. One biopsy specimen was sent for pathology examination and classified according to the predominant histological pattern, i.e., Sertoli-cell only (SCO), maturation arrest (MA) and hypospermatogenesis (HYPO), while the other was dissected and examined for the presence of sperm in the embryology laboratory (EL). After that, the testicular microdissection was carried out as described by Schlegel (1998), with minor modifications. Tubules were sent to the EL for sperm search. Successful sperm retrieval (SSR) rates, both overall and stratified by histology category, were compared between conventional and microsurgical TESE. Overall, the SSR rate was significantly higher using micro-TESE (27/60; 45%) as compared to TESE (15/60; 25%; P=0.02). In successful retrievals, a positive retrieval with TESE was always coupled with a positive one by micro-TESE. SSR rates according to testicular histology results were 92.9% (13/14), 63.6% (7/11) and 20.0% (7/35) in the subgroups of HYPO, MA and SCO, respectively. In addition, micro-TESE success rates were significantly higher than TESE in all testicular histology categories of HYPO (92.9% micro-TESE; 64.3% TESE), MA (63.6% micro-TESE; 9.1% TESE) and SCO (20% micro-TESE; 5.7% TESE) (P<0.01). Micro-TESE is a better method to retrieve spermatozoa from men with NOA than conventional single-biopsy TESE. SSR rates in NOA, either by micro-TESE or TESE, are correlated to the testicular histopathology results. Regardless of testicular histology category, micro-TESE yields higher SSR rates than TESE.