Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest

Abstract

Objective: To evaluate sperm retrieval in men with nonobstructive azoospermia and maturation arrest (MA) undergoing microdissection testicular sperm extraction (micro-TESE).

Design: Retrospective chart review.

Setting: Tertiary referral center.

Patient(s): Men with nonobstructive azoospermia and MA who underwent micro-TESE.

Intervention(s): Microdissection TESE.

Main outcome measure(s): Sperm retrieval rate (SRR).

Result(s): A total of 211 patients (13%) had a histologic finding of MA at the most advanced level. The overall SRR was 52%. A total of 146 patients were classified as having early MA (arrest at the primary spermatocyte stage), and 65 as having late MA (early spermatid stage). The SRR in men with early, vs. late, MA was 40% vs. 78%. Of the 211 men with MA, 51 had diffuse MA (100% of tubules showed MA). The SRR was significantly lower in men with diffuse vs. focal MA (35% vs. 57%). On multivariable analysis, late MA and higher follicle-stimulating hormone levels were positively associated with successful sperm retrieval.

Conclusion(s): Sperm were successfully identified in up to one half of the men with MA after micro-TESE. Among men with MA, late MA seems to be the best predictor of successful sperm retrieval with micro-TESE.

Keywords: Microdissection testicular sperm extraction; maturation arrest; nonobstructive azoospermia.