Identifying infertile men who may be amenable to a limited testicular dissection at microdissection testicular sperm extraction
DOI:
https://doi.org/10.5489/cuaj.9609Keywords:
male infertility, non-obstructive azoospermia, cryptozoospermia, micro-TESE, mini-incisionAbstract
Introduction: We aimed to compare clinical characteristics of men with non-obstructive azoospermia (NOA) and cryptozoospermia with a successful sperm retrieval after a limited dissection micro-TESE to identify clinical parameters that may help find patients most likely to undergo a limited dissection.
Methods: We retrospectively analyzed a prospective database of 208 infertile men undergoing a first microdissection testicular sperm extraction (micro-TESE) at a high-volume fertility center (March 2015 to June 2025). The stepwise approach begins with five targeted micro-biopsies through a 1 cm tunica albuginea incision. The incision is extended only if sperm are not initially identified.
Results: Among 208 patients, 51 (25%) required a mini-incision micro-TESE with limited dissection, and 157 (75%) underwent an extensive dissection. NOA patients with a successful retrieval after mini-incision dissection had lower follicle-stimulating hormone (FSH) levels than those requiring extensive dissection (15±13 vs. 22±13, p<0.05). Successful cryptozoospermic patients had higher testosterone levels than those requiring extensive dissection (14±5 vs. 8±4 nmol/L, p < 0.05). Receiver operating characteristic (ROC) analysis suggested thresholds of testosterone ≥10nmol/L for cryptozoospermia (sensitivity 0.91, specificity of 0.58) and FSH ≤19 IU/L for men with NOA (sensitivity: 0.81, specificity of 0.52).
Conclusions: A stepwise approach to micro-TESE starting with a mini-incision can frequently allow for successful sperm retrieval with limited testicular dissection. Preoperative serum FSH (in NOA) and testosterone (in cryptozoospermia) may help identify candidates most likely to undergo limited testicular dissection at micro-TESE.
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