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Non-obstructive azoospermia (NOA) is the diagnosis of one percent of all men and 10% of men complaining about infertility (1, 2). All NOA patients should be evaluated with complete history and physical examination, with genetic testing (karyotype analysis and Y chromosome microdeletion testing) being offered and performed, which will identify the causes of NOA in up to 17% of men (3, 4). Hormonal profile is also important as up to 47% of men that have impaired spermatogenesis with NOA were found to have hypogonadism (4,5). For this situation and after the breakthrough of intracytoplasmic sperm injection (ICSI) in 1992, a man with NOA can be a genetic father if it is possible to obtain viable sperm directly from his testis. Classically, there are two ways to perform it: percutaneously (TESA – TEsticular Sperm Aspiration) through fine needle aspiration (FNA) which is dependent on a small amount of sampling or surgically. Nowadays, there are two basic surgical techniques to retrieve sperm: conventional TEsticular Sperm Extraction (cTESE) and testicular microdissection (or also micro-TESE), which is the topic of this session Difference of Opinion. Until recently, cTESE was considered gold standard for retrieving sperm in men with NOA (6). During a cTESE procedure, the testis is exposed through a small incision and one or multiple biopsies more commonly are taken randomly under direct sight (6). According to Donoso et al., cTESE has an average retrieval rate around 50% in NOA men (6, 7). This procedure is performed under general or regional anesthesia in a daily-basis clinical center. Testicular microdissection was first introduced in 1999 (6, 8). Micro-TESE consists of an equatorial testicular opening in order to retrieve engorged seminiferous tubules that are more likely to contain active spermatogenesis, with the use of a surgical microscope (6). This procedure requires admittance to a hospital and general or regional anesthesia.

Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: Yes