Micro-TESE Success Rate in Non-Obstructive Azoospermia
Microdissection testicular sperm extraction (micro-TESE) has a success rate of 40-60% for sperm retrieval in patients with non-obstructive azoospermia (NOA). 1
Success Rates by Procedure Type
- Micro-TESE offers significantly higher sperm retrieval rates compared to conventional TESE, with studies showing micro-TESE is approximately 1.5 times more effective 1, 2
- Overall sperm retrieval rates for micro-TESE range from 42.9% to 63%, compared to 16.7% to 45% for conventional TESE 3, 4
- A comprehensive review of 4,895 patients found that micro-TESE retrieved sperm in 46.6% of men with NOA, with rates varying between 18.4-70.8% depending on patient characteristics 5
- For patients who have not undergone previous sperm retrieval attempts (naïve population), the sperm retrieval rate with micro-TESE was 46.8% 5
- In salvage procedures (after failed previous retrieval attempts), micro-TESE still achieved a 39.1% success rate 5
Factors Affecting Success Rates
Testicular Histology
Genetic Factors
- Complete AZFa and AZFb Y-chromosome microdeletions predict extremely poor outcomes, with sperm retrieval likelihood approaching zero 1
- Genetic testing should be performed prior to attempting micro-TESE in NOA patients 2
Hormonal Parameters
- FSH levels correlate inversely with sperm retrieval success - lower FSH levels are associated with better outcomes 4
- Testicular volume positively correlates with sperm retrieval rates - larger testicular volumes yield better outcomes 4
Technical Advantages of Micro-TESE
- Micro-TESE uses operative microscopy to identify seminiferous tubules more likely to contain sperm 1, 2
- The procedure allows for extensive examination of testicular tissue while minimizing the amount of tissue removed 2
- Dilated and opaque seminiferous tubules identified during micro-TESE are more likely to contain sperm 6
- Micro-TESE has lower complication rates compared to conventional TESE, including reduced risk of hematoma and fibrosis 1, 3
Clinical Outcomes After Successful Retrieval
- Sperm retrieved through micro-TESE show adequate fertilizing ability when used for ICSI, with fertilization rates of approximately 57% 5
- Clinical pregnancy rates of around 39% and live birth rates of about 24% have been reported in couples who had embryo transfer using sperm retrieved via micro-TESE 5
- No significant differences in ICSI outcomes have been observed between fresh and cryopreserved sperm retrieved through micro-TESE 2
Potential Complications
- Micro-TESE is associated with low short-term postoperative complication rates (approximately 3%) 5
- Recovery of baseline testosterone levels is generally observed during long-term follow-up 1
- Micro-TESE has less impact on postoperative testosterone levels compared to conventional TESE, though testosterone deficiency requiring replacement therapy remains a risk 2
In conclusion, micro-TESE offers the best chance for sperm retrieval in men with NOA, with success rates of 40-60% depending on various factors, particularly testicular histology. The procedure is safer than conventional TESE and should be considered the preferred surgical approach for sperm retrieval in men with NOA.