Non-obstructive azoospermia: Micro-TESE combined with advanced sperm processing for enhanced assisted reproductive outcomes.

INTRODUCTION

Non-obstructive azoospermia (NOA), which accounts for 10% of male infertility cases, is managed by microdissection testicular sperm extraction (mTESE), currently consider the gold standard technique. While mTESE improves sperm retrieval rates (SRR) and minimizes testicular damage, this is only the first step in the assisted reproductive technology (ART) pathway, whose goal is live birth. Advanced sperm preparation techniques, including SpermVD® vitrification and synchronous oocyte retrieval, may further optimize outcomes. However, live birth and ongoing pregnancy rates (LBR) after mTESE remain poorly reported. This study aimed to evaluate reproductive outcomes following mTESE combined with advanced sperm preparation techniques in NOA.

MATERIALS &

METHODS

This retrospective study included 55 patients with NOA who underwent mTESE between July 2019 and March 2023. The primary outcomes included LBR, while the secondary outcome concerned SRR. Univariate analyses were performed to identify risk factors associated with unsuccessful sperm retrieval.

RESULTS

Mean age was 36.6years, mean FSH level of 20.9IU/L and mean testicular volume was 7.4mL. SRR was 47.3% (95% CI: 34.2% - 60.4%) and increased to 53.2% after excluding Klinefelter patients. Live birth and ongoing pregnancies were achieved in 27.3% of couples (95% CI: 15.5% - 39.1%) and 57,7% of positive biopsies (95%. CI: 38,5% - 76,9%). Karyotype abnormalities (P=0.025), elevated FSH (P=0.029), and familial infertility (P=0.003) were associated with unsuccessful sperm retrieval.

CONCLUSION

In our cohort, mTESE enabled 27.3% of couples to achieve a live birth or ongoing pregnancy without requiring sperm donation.