Application of microdissection testicular sperm extraction for patients with non-obstructive azoospermia

To investigate the value and safety of microdissection testicular sperm extraction（MD-TESE）for patients with non-obstructive azoospermia（NOA）.

A retrospective analysis study of 176 NOA patients diagnosed in our center from July 1, 2017 to March 15, 2022. According to sperm retrieval methods, they were divided into MD-TESE group and testicular sperm aspiration（TESA）group. The time of procedure, intra-operative bleeding, surgical complications（such as hematoma）, sperm retrieval rate（SRR）and clinical outcome of in vitro fertilization were compared between the 2 groups.

There were no significant differences between the 2 groups in age, body mass index（BMI）, testicular volume, and levels of testosterone（T）, luteinizing hormone（LH）, anti-Müllerian hormone（AMH）and follicle-stimulating hormone（FSH）（P>0.05）. The MD-TESE group had obviously longer operation time（P<0.001）and lower incidence of testicular hematoma rate[2.4%（1/42）vs 7.5%（10/134）] than the TESA group. No infections were observed in either group. SRR was significantly higher in MD-TESE group than the TESA group[38.1%（16/42）vs 9.0%（12/134）, P<0.001]. When the obtained sperms were used in intracytoplasmic sperm injection（ICSI）, no obvious differences were seen in the fertilization rate, cleavage rate, and clinical pregnancy rate between the MD-TESE group and TESA group（65.1% vs 58.3%, 93.9% vs 71.4%, 50.0% vs 50.0%）.

MD-TESE is a safe and effective method for sperm retrieval in NOA patients, especially in those with cryptorchidism, viral orchitis and Y-chromosome AZFc microdeletions.