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Multiple needle‐pass percutaneous testicular sperm aspiration as first‐line treatment in azoospermic men
Author(s) -
Jensen C. F. S.,
Ohl D. A.,
Hiner M. R.,
Fode M.,
Shah T.,
Smith G. D.,
Sonksen J.
Publication year - 2016
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/andr.12143
Subject(s) - testicular sperm extraction , sperm retrieval , azoospermia , medicine , intracytoplasmic sperm injection , obstructive azoospermia , gynecology , infertility , pregnancy , biology , genetics
summary Percutaneous testicular sperm aspiration ( TESA ) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates ( SRR ) when compared with microdissection testicular sperm extraction (m TESE ), many centers now use m TESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia ( NOA ). Objectives of this study were to evaluate the outcome and safety of TESA and m TESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle‐pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia ( OA ). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to m TESE . Main outcome measures were complication rates and SRR . SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA . In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with m TESE . Overall complication rates of TESA and m TESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA . Men with a failed TESA have a limited chance of sperm retrieval using m TESE . Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or m TESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.