A novel stepwise micro-TESE approach in non obstructive azoospermia

Area of Science:

• Reproductive Medicine
• Urology
• Andrology

Background:

• Non-obstructive azoospermia (NOA) presents challenges for sperm retrieval.
• Conventional single testicular sperm extraction (TESE) and micro-TESE are established methods.
• Poor prognosis NOA patients often have low sperm retrieval rates (SRR).

Purpose of the Study:

• To evaluate a novel stepwise micro-TESE approach for improving SRR in poor prognosis NOA patients.
• To compare the efficacy of stepwise micro-TESE against conventional single TESE and contralateral multiple TESE.
• To identify predictors of sperm retrieval in NOA patients undergoing TESE.

Main Methods:

• A stepwise micro-TESE protocol was implemented in 64 poor prognosis NOA men.
• Inclusion criteria included prior failed TESE, unfavorable histology, or Klinefelter syndrome.
• The stepwise approach involved: 1) single conventional TESE, 2) micro-TESE on the same testis, 3) contralateral multiple TESE.

Main Results:

• The overall SRR was 28.1% (18/64).
• Micro-TESE did not yield higher SRR compared to single TESE or contralateral multiple TESE.
• No significant pre-operative predictors for sperm retrieval were identified.

Conclusions:

• Stepwise micro-TESE may offer a structured approach to gradually increase surgical invasiveness for NOA patients.
• This method could potentially reduce costs, time, and surgical effort.
• The stepwise approach should be considered for NOA patients requiring sperm retrieval.