The Infertile Male-5: Management of Non-Obstructive Azoospermia

Abstract

Surgical testicular sperm retrieval for intra-cytoplasmic sperm injection purposes is the only possibility of biological fathering in case of non-obstructive azoospermia (NOA). Successful retrieval only correlates with histology, not with FSH values or testicular volume. Testicular sperm extraction (TESE) (mean of successful retrievals in the literature: 52.7{\%}) is the technique of choice: we had successful retrievals in 100{\%} of cases of hypospermatogenesis with >5 spermatids/tubule (spd/tub), 81.8{\%} of cases of hypospermatogenesis with <4 spd/tub, 50{\%} of cases of maturation arrest, and 25{\%} of cases of histologically pure Sertoli cell only syndrome. Microsurgical TESE (MicroTESE) has been reported to increase successful retrievals: from 16.7 to 45{\%} for standard TESE to 42.9--63.6{\%} for MicroTESE, depending on the distribution of testicular histology in the various case studies. TeFNA does not appear to be indicated in NOA, both because of its low success rates---which, in practice, are only positive in hypospermatogenesis, and because it is unable to detect any carcinomas in situ. Previous surgery of left varicocele in NOA could increase the chances of subsequent recovery.