Efficacy of the second micro–testicular sperm extraction after failed first micro–testicular sperm extraction in men with nonobstructive azoospermia

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Authors:

Oktay Özman, M.D., Süleyman Tosun, M.D., Numan Bayazıt, M.D., Sami Cengiz, M.D., Mustafa Emre Bakırcıoğlu, M.D. 

Abstract:

Objective

To evaluate the efficacy of the second micro–testicular sperm extraction (TESE)in men with nonobstructive azoospermia in whom the first micro-TESE failed.


Design

Retrospective.


Setting

Private clinic.


Patient(s)

One hundred twenty-five men with nonobstructive azoospermia with failed previous micro-TESE. The patients were divided into 2 groups according to their surgical sperm retrieval status during the second micro-TESE. If sperm could not be found, these patients were classified as Group 1, and, if sperm was found, the patients were classified as Group 2. The 2 groups were compared for clinical parameters and pathologic findings.


Intervention(s)

Micro-TESE.


Main Outcome Measure(s)

Surgical sperm retrieval status.


Result(s)

Sperm was recovered successfully in 23 of 125 (18.4%) men with the second micro-TESE. Testicular volume was significantly lower in Group 2 (8.2 ± 5.4 mL) than Group 1 (11.3 ± 5.3 mL). Seven of 14 (50%) patients with Klinefelter’s Syndrome had sperm recovery with repeat micro-TESE. The sperm retrieval rate was significantly higher in the Leydig cell hyperplasia and tubular sclerosis groups than in the Sertoli cell only and maturation arrest groups (54.5%, 10.1%, and 18.6%, respectively).


Conclusion(s)

On the basis of our results, 18.4% of men with failed first micro-TESE had a probability of sperm retrieval with the second micro-TESE. Patients with successful sperm recovery had smaller testicular volumes than those with a failed second attempt. Severe testicular atrophy was not a contraindication for the second micro-TESE in such patients.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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