Sperm Retrieval Success Rate Research Articles

Construction of m6A-Related Gene Prediction Model and Subtype Analysis in Non-Obstructive Azoospermia Based on Bioinformatics.

Non-obstructive azoospermia (NOA) is a severe and common cause of male infertility. Currently, the most reliable predictor of sperm retrieval success in NOA is histopathology, but preoperative testicular biopsy often increases the difficulty of sperm retrieval surgery. This study aims to explore the characteristics of N6-methyladenosine (m6A) modification in NOA patients and investigate the potential biomarkers and molecular mechanisms for pathological diagnosis and treatment of NOA using m6A-related genes. NOA-related datasets were downloaded from the GEO database. Based on the results of LASSO regression analysis, a prediction model was established from differentially expressed m6A-related genes, and the predictive performance of the model was evaluated using ROC curves. Cluster analysis was performed based on differentially expressed m6A-related genes to evaluate the differences in different m6A modification patterns in terms of differentially expressed genes (DEGs), biological features, and immune features. There were significant differences in eight m6A-related genes between NOA samples and healthy controls. The ROC curves showed excellent predictive performance for the diagnostic models constructed with ALKBH5 and FTO. DEGs of two m6A modification subtypes indicated the influence of m6A-related genes in the biological processes of mitosis and meiosis in NOA patients, and there were significant immune differences between the two subtypes. The NOA pathological diagnostic models constructed with FTO and ALKBH5 have good predictive ability. We have identified two different m6A modification subtypes, which may help predict sperm retrieval success rate and treatment selection in NOA patients.

Association between anti-Müllerian hormone concentrations and sperm retrieval outcomes in patients with idiopathic nonobstructive azoospermia: a systematic review and meta-analysis.

Microdissection testicular sperm extraction (mTESE) is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia (iNOA). However, the success rate of sperm retrieval varies among individuals. We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA. We searched PubMed, EMBASE, and Web of Science from database inception to August 2, 2023. The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE. Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models. The overall sperm retrieval rate was 36.8% (95% confidence interval [CI]: 27.5%-46.0%, I2 = 95.0%) in nine studies comprising 1892 patients with iNOA. No significant differences were found in age, testicular volume, serum total testosterone concentrations, or inhibin B concentrations between positive and negative sperm retrieval outcomes. Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE (weighted mean differences: -2.70; 95% CI: -3.94--1.46, I2 = 79.0%). In conclusion, this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA, while age, testicular volume, total testosterone, and inhibin B show no significant association. These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.

An integrative prediction model of successful sperm retrieval for men with non-obstructive azoospermia.

Microdissection testicular sperm extraction (micro-TESE) is an efficient method for obtaining spermatozoa from patients with non-obstructive azoospermia, but the overall success rate of this surgery is only approximately one-third. This study aimed to construct an integrative prediction model for andrologists to assess the preoperative success retrieval rate. A total of 217 patients diagnosed with non-obstructive azoospermia at the First Affiliated Hospital of Nanjing Medical University were included, in whom sperm was successfully retrieved in 71 patients. We retrospectively analyzed their clinical characteristics and pathological features. Single factor analysis and logistic regression analysis were utilized to validate the predictive performance, and the area under the curve (AUC) analysis was conducted to further assess the clinical diagnostic value of the model. The results showed that a history of Klinefelter syndrome or cryptorchidism, FSH (Follicle Stimulating Hormone) levels, and testicular pathology contributed differently to the nomogram prediction model. Relatively normal FSH levels, a history of Klinefelter syndrome or cryptorchidism, and favorable testicular pathological types were assigned higher scores, with higher scores often accompanying a preferable success rate of sperm retrieval. The integrated model showed good prediction performance, with an AUC (Area Under the Curve) of 0.781 (95% CI (confidence interval) 0.713-0.849). Overall, our integrative model demonstrates excellent prediction performance and may assist andrologists in balancing the benefits of surgery preoperatively.

AI Model Developed Using Machine Learning for Predicting Sperm Retrieval in Micro-TESE for Nonobstructive Azoospermia Patients

Azoospermia is a severe problem that prevents couples from having their own children through natural pregnancy. In nonobstructive azoospermia (NOA), microdissection testicular sperm extraction (micro-TESE) is required to collect sperm and, at 40%–60%, the sperm retrieval success rate is not very high. Previous studies identified no single clinical finding or investigation that could accurately predict the outcome of sperm retrieval. It would be very valuable to have a factor for predicting the possibility of sperm retrieval in patients with NOA before performing micro-TESE. We retrospectively obtained data from the medical records of 430 patients who underwent micro-TESE from 2011 to 2020. Parameters extracted were age, height, body weight, body mass index, luteal hormone, follicle-stimulating hormone, PRL, total testosterone, E2, T/E2, sperm retrieval, G-band, AZF, medical history, Rt testis, and Lt testis. Prediction One, which does not require coding, was used to create the AI prediction model for sperm retrieval. Prediction One makes the best prediction model using an artificial neural network with internal cross-validation. Prediction One also evaluates the “importance of variables” using a method based on permutation feature importance. The AUC for the AI model was 0.7246, which is acceptable. In addition, among the variables, T/E2 ratios contributed most to predicting whether sperm retrieval was possible or not. However, the difference in T/E2 between successful and unsuccessful sperm retrieval was not statistically significant. In addition, our analysis of data from 20 patients who underwent micro-TESE in 2021 found that in 85%, the actual result matched the result predicted using our novel AI model. We created an AI model for predicting sperm retrieval in patients with NOA before undergoing micro-TESE. In addition, we found that T/E2 ratios contributed most to predicting possibility of sperm retrieval in NOA using machine learning.

O-140 studying the effect of mosaicism on the outcome of micro-TESE among Klinefelter syndrome patients

Abstract Study question Does mosaicism affect sperm retrieval rate in Klinefelter patients? Summary answer Patients with mosaic Klinefelter syndrome (KS) have a higher success rate of sperm retrieval than those with non-mosaic KS. What is known already Klinefelter syndrome is characterised by the presence of an extra X chromosome in male individuals leading to a 47XXY karyotype and rarely to 46XY/47XXY Mosaicism; it is the most common sex chromosomal aneuploidy and the most common genetic cause of Azoospermia (Kanakis GA et al., 2018 and Gravholt CH et al.,2018). It accounts for 3–4% of male infertility cases and 10–12% of men with Azoospermia (Winters SJ,2018). Study design, size, duration After approval of the ethical committee of the faculty of medicine at Cairo University, This prospective study was conducted where 70 men who complained of primary infertility and azoospermia and were diagnosed with Klinefelter Syndrome were recruited for this study between 1/11/2021 and 30/11/2022. Patients with previous testicular disease (torsion, trauma) or who had a history of undescended testes or received chemotherapy or radiotherapy were excluded. Participants/materials, setting, methods Seventy patients (n = 70) aged between 20 and 50 who fit the inclusion criteria were recruited and underwent micro_TESE. Semen analysis (Azoospermia), hormonal profile, scrotal colour doppler ultrasonography, Karyotyping and FISH for Y and X chromosomes were performed. Statistical analysis was conducted using SPSS 22nd edition. Main results and the role of chance Our study groups comprised 14 patients with mosaic KS and 56 with non-mosaic KS. The clinical characteristics were not significantly different statistically between the two groups. Micro_TESE was performed in all 70 patients; in 26 patients (37.1%), mature sperm were found in the wet preparation. No statistically significant correlation was found between the presence of spermatozoa in the extraction specimen and age, serum follicle-stimulating hormone, serum testosterone, prolactin or oestradiol. The statistically significant predictor variable for sperm extraction was mosaicism, luteinising hormone, testicular volume and FISH. The sperm retrieval rate of the patients with mosaic and non-mosaic KS was 57.1% and 32.1%, respectively. Limitations, reasons for caution 1) Larger (n) number of patients was needed. 2) Despite our valuable findings, further studies should be performed to illuminate the relation between FISH for X and Y chromosomes and sperm retrieval rate success. Wider implications of the findings Klinefelter patients with mosaicism should be offered high sperm retrieval rate during IVF counselling. Trial registration number n/a

MP30-02 A NOVEL PREDICTION MODEL FOR POSSIBILITY OF SPERM RETRIEVAL IN MICRO TESE FOR NON-OBSTRUCTIVE AZOOSPERMIA PATIENTS USING AUTOMATED ARTIFICIAL INTELLIGENCE

You have accessJournal of UrologyCME1 Apr 2023MP30-02 A NOVEL PREDICTION MODEL FOR POSSIBILITY OF SPERM RETRIEVAL IN MICRO TESE FOR NON-OBSTRUCTIVE AZOOSPERMIA PATIENTS USING AUTOMATED ARTIFICIAL INTELLIGENCE Hideyuki Kobayashi, Masato Uetani, Koichi Nakajima, and Koichi Nagao Hideyuki KobayashiHideyuki Kobayashi More articles by this author , Masato UetaniMasato Uetani More articles by this author , Koichi NakajimaKoichi Nakajima More articles by this author , and Koichi NagaoKoichi Nagao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Azoospermia is a severe problem that prevents couples from having their own children through natural pregnancy. In non-obstructive azoospermia (NOA), a particularly severe type of male infertility, microdissection testicular sperm extraction (micro TESE) is required to collect sperm and, at 40-60%, the sperm retrieval success rate is not very high.Previous studies identified no single clinical finding or investigation that could accurately predict the outcome of sperm retrieval. In addition, although clinical and hormone parameters have been previously investigated as potential predictors of sperm retrieval, the evidence for them has been conflicting and a specific biochemical marker predicting the possibility of sperm retrieval has yet to be established. It would be very valuable to know the possibility of sperm retrieval for patients with NOA before performing micro TESE. Therefore, our objective was to make a model for predicting the possibility of sperm retrieval in patients with NOA before performing micro TESE, using machine learning. METHODS: We retrospectively obtained data from the medical records of 430 patients who underwent micro TESE from 2011 to 2020. Parameters extracted were age, height, body weight, body mass index, LH, FSH, FSH, PRL, total testosterone, E2, T/E2, sperm retrieval, G-band, AZF, medical history, Rt testis, and Lt testis. Prediction One, which does not require coding, was used to create an AI prediction model for sperm retrieval. Prediction One makes the best prediction model using an artificial neural network (ANN) with internal cross validation. RESULTS: The mean age of the 430 male patients who underwent micro TESE in this study was 36.78±7.58 years. Sperm was successfully retrieved in 151 (35.1%) patients.Statistically significant differences between successful and unsuccessful sperm retrieval were observed for age, LH, FSH, total testosterone, Rt testis, Lt testis and medical history. Medical history included none, Lt varicocele, cryptorchidism, inguinal hernia, torsion of spermatic cord, orchitis, cancer treatment, spinal injury, spina bifida, and anti-sperm antibody (+). The AUC for the AI model was 72.46%, which is acceptable. The values for Accuracy, Precision and Recall were 72.09%, 64.76% and 45.03%, respectively, when the F-value was 53.13%. CONCLUSIONS: We created an AI model for predicting sperm retrieval in patients with NOA before undergoing micro TESE. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e391 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideyuki Kobayashi More articles by this author Masato Uetani More articles by this author Koichi Nakajima More articles by this author Koichi Nagao More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors influencing the sperm retrieval rate of microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome.

To investigate the factors affecting the sperm retrieval rate of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS), 64 patients with nonmosaic KS who underwent micro-TESE in the Center for Reproductive Medicine of Peking University Third Hospital (Beijing, China) between January 2016 and December 2017 were included in the study. Data on medical history, physical examination and laboratory examination results, and micro-TESE outcomes were collected. Patients were divided into two groups according to micro-TESE outcomes. The following factors were compared between the two groups by the Mann ‒ Whitney U test or Student's t-test based on the distribution (nonnormal or normal) of the factors: age, testicular size, follicle-stimulating hormone level, luteinizing hormone level, testosterone level, and anti-Müllerian hormone level. The overall success rate of sperm retrieval was 50.0%. Correlation analysis showed that testicular volume was positively correlated with testosterone level. Using a logistic regression model, age and anti-Müllerian hormone levels were found to be better predictors for the sperm retrieval rate than the other parameters.

Mate-pair genome sequencing reveals structural variants for idiopathic male infertility.

Currently, routine genetic investigation for male infertility includes karyotyping analysis and PCR for Y chromosomal microdeletions to provide prognostic information such as sperm retrieval success rate. However, over 85% of male infertility remain idiopathic. We assessed 101 malepatients with primary infertility in a retrospective cohort analysis who have previously received negative results from standard-of-care tests. Mate-pair genome sequencing (large-insert size library), an alternative long-DNA sequencing method, was performed to detect clinically significant structural variants (SVs) and copy-number neutral absence of heterozygosity (AOH). Candidate SVs were filtered against our in-house cohort of 1077 fertile men. Genes disrupted bypotentially clinically significant variants were correlated with single-cellgene expression profiles ofhuman fetal and postnatal testicular developmental lineages and adult germ cells. Follow-up studies were conducted for each patient with clinically relevant finding(s). Molecular diagnoses were madein 11.1% (7/63) of patients with non-obstructive azoospermia and 13.2% (5/38) of patients with severe oligozoospermia. Among them, 12 clinically significant SVs were identified in 12 cases, including five known syndromes, one inversion, and six SVs with direct disruption of genes by intragenic rearrangements or complex insertions. Importantly, a genetic defect related to intracytoplasmic sperm injection (ICSI) failure was identified in a patient withnon-obstructive azoospermia, illustrating the additional value of an etiologic diagnosis in addition to determining sperm retrieval rate. Our study reveals a landscape of various genomic variants in 101 males with idiopathic infertility, not only advancing understanding of the underlying mechanisms of male infertility, but also impacting clinical management.

Endocrine Tests and/or Testicular Volume are Not Predictive of Successful Sperm Retrieval by Conventional Multiple Testicular Sperm Extraction in Nonobstructive Azoospermia

Objectives: This study aimed to determine the role of presurgical markers in the prediction of sperm retrieval by conventional Multiple Testicular Sperm Extraction in infertile Vietnamese men with nonobstructive azoospermia (NOA). Patients and Methods: Retrospective descriptive analysis of 136 infertile men with azoospermia, examined from August 2014 to July 2018. Patients underwent stepwise surgical sperm retrieval via percutaneous epididymal sperm aspiration, testicular sperm aspiration, then conventional multiple testicular sperm extraction in up to three locations, and procedures stopped as soon as sperm were detected. Factors were analyzed to determine the prediction of the likelihood of successful sperm retrieval, in men with NOA. Results: The overall success rate of sperm retrieval in men with azoospermia was 49.3%, but it was only 18.4% in NOA group. The difference in testicular volume between men with successful sperm retrieval and unsuccessful sperm retrieval was not statistically significant in NOA group (5.68 ± 2.37 vs. 4.46 ± 2.83, p = 0.138). The differences in the endocrine tests between the two groups were also not significant in terms of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (p [Formula: see text] 0.05). Multivariable analysis of predictive factors of sperm retrieval in NOA groups found no significant difference, except testicular density (p = 0.015). Conclusions: In infertile men with NOA, neither an endocrine test nor testicular volume should be used for predicting the results of surgical sperm retrieval by conventional multiple testicular sperm extraction.

Genetic diagnosis and sperm retrieval outcomes for Chinese patients with congenital bilateral absence of vas deferens.

Congenital bilateral absence of the vas deferens (CBAVD) is a frequent cause of obstructive azoospermia. CBAVD is mainly caused by mutations in the CFTR (cystic fibrosis transmembrane conductance regulator) gene and is also related to the X-linked ADGRG2 (adhesion G protein-coupled receptor G2) gene. Genetic screening and counseling strategies for Chinese CBAVD populations remain controversial because the genetic background of CBAVD in Chinese population is largely unknown. In this study, we aimed to study the mutation spectrum of CFTR and ADGRG2 in a group of CBAVD patients and to evaluate sperm retrieval outcomes in a subset of CBAVD patients. Next-generation targeted sequencing was used to identify mutations in the CFTR and ADGRG2 genes in 38 CBAVD patients. In addition, we followed and analyzed nine of the 38 patients who were undergoing sperm retrieval surgery. In total, 27 of 38 (71.05%) patients carried at least one likely pathogenic or pathogenic mutation in CFTR or ADGRG2. In addition to the IVS9-5T allele, 15 CFTR and 1 ADGRG2 mutations were identified, including 4 novel mutations. CFTR hot-spot mutations were not identified in our study. Spermatozoon was successfully obtained in all nine patients who underwent MESA or TESE surgery, but most patients had spermatozoa with relatively low motility and high abnormality rates. Except for the IVS9-5T allele, hot-spot mutations of CFTR may not exist in Chinese CBAVD patients. Therefore, next-generation targeted sequencing for whole CFTR and ADGRG2 gene may be the appropriate genetic testing method, and genetic counseling may be different from Caucasian populations. We observed a high success rate of sperm retrieval with relatively low motility and high abnormality rates in Chinese CBAVD patients. However, this is only a weak conclusion due to the small sample size.

Sperm retrieval rate and reproductive outcome of infertile men with azoospermia factor c deletion.

To evaluate the success rate in sperm retrieval (SR) through microdissection testicular sperm extraction (micro-TESE) in infertile azoospermia factor c (AZFc)-deleted men and determining their reproductive outcomes following ICSI, medical records of couples with AZFc-deleted male partners were reviewed on patient's age, serum hormone levels, karyotype, testicular pathology and pregnancy outcomes. A comparison on age and serum hormone level was conducted between groups with positive and negative sperm retrieval in both azoospermic and oligozoospermic AZFc-deleted men. Of 225 who had AZFc deletion, 195 cases followed clinical treatments. From 195 cases, 116 were azoospermic, 79 were oligozoospermic. Pathology profile was available in 103 of 195 subjects which the predominant trait was SCOS and was seen in 66.9% of cases (69 of 103). Success rate of sperm retrieval in azoospermic patients who underwent micro-TESE was 36.3% (28/77). Forty-three oligozoospermic and 17 azoospermic patients started ART cycle. Pregnancy rate in oligozoospermic group was 35.4% (17 cases), whilst there was no clinical pregnancy in azoospermic group. In conclusion, the pregnancy and delivery in oligozoospermic patients with AZFc deletion are comparable with other studies, but despite of sperm retrieval in azoospermic patients with AZFc deletion, the chance of pregnancy or delivery in these patients was very low.

Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia

Despite the improved success rate of sperm retrieval by microdissection testicular sperm extraction (micro-TESE), methods to stimulate spermatogenesis in men with non-obstructive azoospermia (NOA) remain unexplored. The aim of this study was to evaluate the effects of hCG-based hormonal stimulation in men with NOA on the success of sperm retrieval by micro-TESE. Forty-eight men with NOA who had negative sperm retrieval results by the micro-TESE procedure were included. A second micro-TESE was subsequently performed on these men: 20 were not treated by any hormonal therapy, and 28 subjects received daily subcutaneous injections of hCG for 4-5 months prior to the second micro-TESE. Recombinant FSH was added if endogenous gonadotrophin levels decreased during the hCG stimulation. The sperm retrieval rate at the second micro-TESE; the levels of gonadotrophins, testosterone and estradiol; and the effects of hormonal therapy on testicular histology were evaluated. Among the 28 men with hCG stimulation, 15 (54%) showed decreased LH and FSH levels (0.67 ± 0.10 and 0.96 ± 0.14 mIU, mean ± SEM, respectively) due to elevated serum testosterone (9.5 ng/dl). Sperm were obtained at the second micro-TESE from six men who had received hormonal therapy (21%), whereas no sperm were retrieved from untreated men (P < 0.05). Success at the second micro-TESE was more likely if histology at the first micro-TESE showed hypospermatogenesis. The Leydig cells of the testis can respond positively to exogenous hCG even under hypergonadotropic conditions. HCG-based hormonal therapy prior to a second micro-TESE attempt is effective in men with hypospermatogenesis.

Sperm Retrieval and Intracytoplasmic Sperm Injection in Men With Nonobstructive Azoospermia, and Treated and Untreated Varicocele

We evaluated the impact of varicocelectomy on the sperm retrieval success rate using microsurgical testicular sperm extraction and intracytoplasmic sperm injection in men with clinical varicocele and nonobstructive azoospermia. The study included 96 men with complete nonobstructive azoospermia with a history of clinical unilateral or bilateral varicocele. Of the patients 66 previously underwent successful varicocelectomy and 30 had any grade of varicocele at sperm extraction. Mean patient age was 34.8 and 32.3 years in the treated and untreated groups respectively. There were no differences in mean follicle-stimulating hormone, testicular volume, infertility duration or female partner age between the 2 groups. The proportion of female factor problems in the 2 groups was similar. The distribution of varicocele grade in the treated and untreated groups was not different. The sperm retrieval rate was significantly higher in the treated group (53% vs 30%, OR 2.63, 95% CI 1.05-6.60, p = 0.036). There was no significant difference in the normal 2PN fertilization rate (63.9% vs 53.6%). The rate of high quality embryos and mean number of transferred embryos were similar in the groups. The clinical pregnancy rate in the treated and untreated groups was 31.4% and 22.2%, respectively (p >0.05). Our results suggest that varicocele repair significantly increased the sperm retrieval rate in patients with clinical varicocele and nonobstructive azoospermia.

Success of TESE-ICSI in men with non-mosaic Klinefelter syndrome

Objective: To determine the success rate of sperm retrieval using testicular sperm extraction (TESE) in men with non-mosaic Klinefelter syndrome (47,XXY). Further, fertilization and pregnancy rates after intra-cytoplasmic sperm injection (ICSI) in this cohort of patients and their partners were evaluated.

Predictive factors of successful testicular sperm recovery in non-obstructive azoospermia patients.

Recovery of testicular spermatozoa from non-obstructive azoospermic patients for intracytoplasmic sperm injection (ICSI) is a recent advance in the treatment of male infertility. The purpose of this study is to identify predictive factors for sperm recovery in non-obstructive azoospermic patients. A total of 178 men with non-obstructive azoospermia had multiple testicular sperm extraction (TESE) procedures to recover spermatozoa for intracytoplasmic sperm injection (ICSI) from June 1996 to February 1999. Testicular volume, serum follicle stimulating hormone (FSH) level and testicular histology were examined as positive predictive factors for sperm recovery. Testis biopsies were categorized as severe hypospermatogenesis, maturation arrest and Sertoli cell-only syndrome based on the most advanced pattern of spermatogenesis seen on histology. Sperm retrieval success rates for the patients in three histopathological categories were compared. Spermatozoa were successfully recovered in 94 of 178 (52.8%) men. Sperm were retrieved in 13 of 80 (16.3%) with Sertoli cell-only syndrome, 15 of 24 (62.5%) with maturation arrest, and 66 out of 74 (89.2%) with severe hypospermatogenesis. Spermatozoa recovery has no correlation with testicular volume or serum FSH level. When compared against Sertoli cell-only syndrome, the odds of sperm retrieval success rate was 44.3 times higher in severe hypospermatogenesis and 8.4 times in maturation arrest. These results demonstrate meaningful correlation between successful testicular sperm recovery and testis histopathology. Only testicular histopathology can be used as a predictor of successful sperm recovery.

Epididymal and testicular sperm retrieval in azoospermic patients and the outcome of intracytoplasmic sperm injection in relation to the etiology of azoospermia

Spermatozoa retrieved by percutaneous epididymal sperm aspiration (PESA) or percutaneous testicular sperm aspiration (TESA) and by open biopsy for testicular sperm extraction (TESE) can fertilize human oocytes by intracytoplasmic sperm injection (ICSI), thus enabling azoospermic men to become fathers. However, the sperm retrieval success rate is higher in patients with obstructive azoospermia (OA) than from those with nonobstructive azoospermia (NOA). The present retrospective study reports on the sperm retrieval success rate with the use of PESA in patients with OA, and with TESA and/or TESE in patients with NOA. We also have related the outcome of ICSI to the etiology of the azoospermia.