Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine-needle aspiration mapping in patients with nonobstructive azoospermia

Abstract

Objective: To evaluate intracytoplasmic sperm injection (ICSI) outcomes in a cohort of men with nonobstructive azoospermia who underwent prior fine-needle aspiration (FNA) “maps” to localize sperm and guide testis sperm extraction (TESE). Design: Retrospective clinical study. Setting: University-based infertility practice. Patient(s): A consecutive cohort of 19 infertile, azoospermic men. Intervention(s): Couples underwent IVF-ET in which TESE procedures were informed and directed by prior FNA maps of the testis. Main Outcome Measure(s): Sperm retrieval and pregnancy rates. Result(s): In 21 IVF-ET and ICSI cycles, sufficient sperm for all oocytes were retrieved in 20 TESE attempts (95%). A mean of 3.1 biopsies per patient were required, with an average size of 72 mg. Mean operative time for the TESE procedure was 88 minutes. Overall, the two-pronuclear fertilization rate was 66%; ongoing clinical pregnancies were obtained in 10 of 21 initiated cycles (48%). Conclusion(s): In an effort to reduce IVF-ET cancellation rates in cases of nonobstructive azoospermia, diagnostic testis FNA can define those patients who are good candidates for TESE. It also directs sperm retrieval and minimizes tissue removal from nonobstructed testes.