Application of microdissection testicular sperm extraction for patients with non-obstructive azoospermia

Abstract

Objective To investigate the value and safety of microdissection testicular sperm extraction (MD-TESE) for patients with non-obstructive azoospermia (NOA). Methods A retrospective analysis study of 176 NOA patients diagnosed in our center from July 1, 2017 to March 15, 2022. According to sperm retrieval methods, they were divided into MD-TESE group and testicular sperm aspiration (TESA) group. The time of procedure, intra-operative bleeding, surgical complications (such as hematoma), sperm retrieval rate (SRR) and clinical outcome of in vitro fertilization were compared between the 2 groups. Results There were no significant differences between the 2 groups in age, body mass index (BMI), testicular volume, and levels of testosterone (T), luteinizing hormone (LH), anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) (P>0.05). The MD-TESE group had obviously longer operation time (P < 0.001) and lower incidence of testicular hematoma rate than the TESA group. No infections were observed in either group. SRR was significantly higher in MD-TESE group than the TESA group. When the obtained sperms were used in intracytoplasmic sperm injection (ICSI), no obvious differences were seen in the fertilization rate, cleavage rate, and clinical pregnancy rate between the MD-TESE group and TESA group (65.1% vs 58.3%, 93.9% vs 71.4%, 50.0% vs 50.0%). Conclusion MD-TESE is a safe and effective method for sperm retrieval in NOA patients, especially in those with cryptorchidism, viral orchitis and Y-chromosome AZFc microdeletions.

Keywords

• non-obstructive azoospermia
• microdissection testicular sperm extraction
• testicular sperm extraction
• sperm retrieval rate
• surgical complications