Testicular mapping-guided sperm retrieval vs. upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live-birth rates.

Abstract

Background: Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM.

Methods: We performed a retrospective cohort study of men with NOA over a 10-year period from 2010 to 2019. The primary outcome was success of SR with secondary outcomes of pregnancy, and live-birth rates.

Results: Ninety men were included in the analysis. 60 in the FNAM group in 30 having upfront microTESE. In the FNAM group, 34/60 (56.7%) patients had positive fine needle aspiration (FNA) map for spermatogenesis. Of these 20/31 (64.5%) had FNAM-guided TESA/E, and 11/31 (35.5%) had microTESE. SR was successful in 30 of 31 men (96.8%). Overall SR rate was 54.4% and 56.7% in the FNAM group and upfront microTESE, respectively. There was no statistical difference in SR (P=0.65). The FNAM group had pregnancy and live-birth rates of 42.1% and 36.8%, respectively. The upfront microTESE group had pregnancy and live-birth rates of 36.7% each. χ² analysis revealed no statistical difference for both pregnancy (P=0.76) and live-birth rates (P=0.75).

Conclusions: FNAM carries high predictability and reliability in SR and can be performed prior to microTESE in NOA patients without change in fertility outcomes.