Surgical Sperm Retrieval
Testis tissue sampling is indicated in men with non-obstructive azoospermia (lack of sperm due to failure of spermatogenesis) desiring to conceive. This may be accomplished with testicular sperm aspiration (TESA), testicular sperm extraction (TESE) or micro-dissection testicular sperm extraction (microTESE). Open biopsy (TESE or microTESE) remains the gold standard in cases of non-obstructive azoospermia because it provides an optimal amount of tissue both for accurate diagnosis and retrieval of sperm for use in assisted reproduction. MicroTESE remains the most accurate and reliable method for retrieving sperm in men with non-obstructive azoospermia.(79) In the general infertile population, microTESE has been shown to yield successful sperm retrieval 1.5 times more often than conventional TESE, and TESE has been shown to yield sperm retrieval 2 times more often than TESA.(80)
In a study by Shin et al, successful sperm retrieval with microTESE was noted in 47 % of adult males with azoopermia after chemotherapy, with a 35% clinical pregnancy rate after IVF/ICSI, yielding a 27% live birth rate.(81) These authors found no significant differences in outcomes between patients with a history of testicular cancer, lymphoma and leukemia. Hsiao et al demonstrated similar successful sperm retrieval rates in men who had a mean time from chemotherapy treatment of 18.6 years.(82) Sperm retrieval rates were demonstrated to be 37%, with a history of testicular cancer treatment having the highest sperm retrieval rates and exposure to alkylating agents resulting in a significantly lower sperm retrieval rate.