The fertility potential of patients with non-obstructive azoospermia (NOA) depends on sperm extraction from the tissue sample
and then in vitro fertilization with intracytoplasmic sperm injection
(IVF/ICSI). Testicular sperm extraction (TESE) from the
limited sites of sperm production in the testes of men with NOA
has been a primary challenge to the successful treatment of these
1 Predictors for Successful Sperm Retrieval of NOA Patients
Combination of FSH level, Inhibin B level and testicular volume
might be the predictors for the successful TESE.
2 Preparation of TESE
Genetic testing to identify the cause of low sperm production
may provide important prognostic and diagnostic information
for men with NOA. NOA patients may have very limited
pockets of sperm production. This limited production should be
optimized before undergoing an invasive procedure. Varicocele,
hormone imbalance and other scrotal surgical procedure must
be carefully considered before TESE procedure.
3 Treatment Approach and IVF/ICSI
Because it was found that only 33% of testicular samples from
men with NOA will reliably survive freeze-thaw and have documentable
viability, the TESE procedures should be carried
during a programmed in vitro fertilization (IVF) cycle, to allow
sperm to be used fresh after sperm extraction. Sperm retrieval is
usually timed to occur on the day before oocyte retrieval. Testicular
sperm often acquire at least twitching motility after they
are retrieved and incubated overnight.
Approaches for sperm retrieval have included fine-needle
aspiration, percutaneous testis biopsy, open testicular biopsy,
multiple testicular biopsy (testicular sperm extraction), and
micro-TESE. Micro-TESE allows identification of the seminiferous
tubules that contain sperm, improving the yield of sperm
retrieval and limiting the amount of testicular tissue that needs
to be removed.