Evaluation of diagnostic testis biopsy and the repetition of testicular sperm extraction surgeries in infertility patients

Testicular sperm extraction (TESE) should be considered regardless of the expected testicular histopathology. The chance of finding sperm by TESE decreases with each successive TESE procedure.

Alayman Fathy Hussein, M.B.B.C.H., M.Sc., M.D.

Volume 100, Issue 1, Pages 88-93, July 2013


To evaluate the use of a diagnostic testis biopsy and a repetition of testicular sperm extraction (TESE) surgeries in azoospermic patients and its impact on the outcome of TESE.

Retrospective, case–control study.

University IVF center and hospital.

A total of 552 azoospermic patients undergoing TESE for intracytoplasmic injection.

At the time of the TESE, a piece of testicular tissue was prepared for histopathologic evaluation.

Main Outcome Measure(s):
Sperm retrieval rate.

Testicular sperm retrieval was successful in 100% of patients with obstructive azoospermia, 95.6% of patients with hypospermatogenesis, 47.9% of patients with maturation arrest, and 28.6% of patients with Sertoli cell–only syndrome in cases with no previous testicular surgery; in 100%, 91.4%, 32%, and 13.3%, respectively, in cases with a history of one testicular surgery; and in 100%, 10%, 0, and 0, respectively, in cases with a history of two testicular surgeries.

Testicular sperm retrieval may be successful for some patients in each histopathologic category of azoospermia, with variable degrees of success for different histopathologic categories. The repetition of testicular surgeries decreases the chance of finding sperm in subsequent testicular sperm retrieval procedures.

  • It is concerning to see the significant decline in successful sperm retrieval on subsequent procedures in this study. This article emphasizes the importance of good surgical technique and hemostasis to avoid fibrosis. Although I may never reach the numbers achieved by Schlegel, I am constantly refining my microTESE technique to give each couple the best chance for sperm retrieval and having biologic children.

  • Mike Hsieh

    Various biopsy techniques were described to predict outcomes of microTESE in NOA men. Unfortunately, they can all result in fibrosis and increase the difficulty during microTESE. This study offers a single center experience of sperm retrieval after multiple biopsies/surgeries. I am interested to see what are other male fertility experts surgical algorithm of their first step in the management of NOA patients (single bx vs. percutaneous mapping vs. microTESE)

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