Microdissection TESE (MD-TESE) Does not Improve Sperm Retrieval Rate but Contributes to Favorable Pregnancy Rate in Non-Obstructive Azoospermic (NOA) Patients

Background and Aims: Microdissection testicular sperm extraction TESE (MD-TESE), which can improve surgical sperm retrieval rate is widely applied in sperm retrieval surgery in non-obstructive azoospermic (NOA) patients. We assessed whether MD-TESE can improve sperm retrieval rate as well as Intracytoplasmic sperm injection (ICSI) results. Methods: A retrospective comparative study involving 86 NOA patients who underwent 6-8 conventional multiple TESE (C-TESE) procedures was conducted. Another 116 NOA patients underwent MD-TESE. CTESE and MD-TESE were employed for the bilateral testis via a median raphe incision under spinal or local anesthesia with spermatic block. Results: Motile sperm recovery was achieved in 26 (30.2%) and 30 (25.8%) patients with C-TESE and MDTESE, respectively. Collected sperm was cryopreserved. All couples in which motile sperm was recovered received ICSI utilizing frozen-thawed sperm samples. Overall pregnancy rates of the C-TESE and MD-TESE groups were 23% (6/26) and 40% (12/30), respectively. Abortion was not observed in either group and healthy deliveries resulted. Statistical differences in sperm recovery and pregnancy rate were not evident between the groups (P=0.495, P=0.182, respectively). Moreover, no successful pre-operative predictors of sperm recovery were identified. Conclusions: These data demonstrated that MD-TESE does not improve sperm recovery rate; however, MD-TESE contributes to favorable pregnancy rate in NOA patients.