Combining microTESE and trifocal TESE improves sperm retrieval and cryopreservation outcomes in nonobstructive azoospermia.

PURPOSE: To evaluate whether combining microdissection testicular sperm extraction (microTESE) with trifocal testicular sperm extraction (TESE) in a single session improves sperm retrieval and cryopreservation outcomes in men with nonobstructive azoospermia.

MATERIALS AND

METHODS

Retrospective cohort study of 93 men with nonobstructive azoospermia (out of 176 consecutive men with azoospermia) who underwent both microTESE and trifocal TESE sequentially during the same procedure was analyzed. Specimens from each technique were processed and analyzed separately to enable within-patient comparison. Sperm retrieval rates, quantitative sperm yield, and cryopreserved vials were measured. Histopathological patterns were classified. Statistical significance was set at p < 0.05.

RESULTS

Sperm retrieval was successful in 59 of 93 patients, resulting in an overall retrieval rate of 63.4%. When analyzed separately, spermatozoa were identified in microTESE specimens from 54 patients (58.1%) and in trifocal TESE specimens from 51 patients (54.8%). The combined approach (analyzing all specimens from both techniques) achieved a significantly higher retrieval rate (63.4%) than either technique analyzed alone (p = 0.041 vs. microTESE; p = 0.002 vs. trifocal TESE). In seven patients (7.5%), sperm were found exclusively in microTESE specimens, and in three patients (3.2%), exclusively in trifocal specimens. Quantitative sperm yield was also higher with the combined approach (mean ± SD: 9.9 ± 5.1 sperm units) than with either microTESE (3.9 ± 3.2) or trifocal TESE (6.0 ± 3.4) specimens alone (p < 0.001). This resulted in more cryopreserved vials (12.4 ± 2.4 vs. 5.9 ± 1.2, p < 0.001), enabling greater fertility preservation potential. Histopathological analysis revealed a mixed atrophy pattern in all successful retrievals, supporting the biological rationale for combining targeted and systematic sampling in patients with focal spermatogenesis.

CONCLUSION

A dual technique approach combining microTESE and trifocal TESE significantly improves sperm retrieval rates and cryopreservation outcomes in nonobstructive azoospermia compared to either technique alone. This strategy maximizes fertility preservation and may reduce the need for repeat testicular procedures.