Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia

The efficiency of testicular sperm retrieval by testicular fine needleaspiration (TEFNA) was compared with open biopsy and testicular spermextraction (TESE), in 37 rigorously selected patients with non- obstructiveazoospermia. All patients underwent TEFNA and TESE consecutively. Thus,each patient served as his own control. The case was regarded as successfulif at least one testicular spermatozoon was found allowing intracytoplasmicsperm injection (ICSI) of at least one oocyte. The mean age of the malepatients was 32.7 years (range 24-47). Whereas by TEFNA spermatozoaenabling performance of ICSI were found in only four patients out of 37(11%), open biopsy and TESE yielded spermatozoa in 16 cases (43%). Thenegative predictive value of high serum follicle stimulating hormone (FSH)concentrations (> or =10 IU/l) (predicting failure to find spermatozoafor ICSI) was low (38.4%). The positive predictive value (predicting thechance to find spermatozoa for ICSI) of normal-sized testicle was notdifferent from that of small- sized (<15 ml) testicle (50%).Complications included one case of testicular bleeding following fineneedle aspiration, treated locally, and two cases of extratunicalhaematomata following TESE requiring no intervention. In patients withnon-obstructive azoospermia, TEFNA has a significantly lower yield comparedto TESE. Performance of ICSI with testicular sperm in these cases resultedin satisfactory fertilization and high embryo transfer rates. Theimplantation and pregnancy rates per embryo transfer were 13 and 29%respectively. Neither serum FSH values nor testicular size were predictiveof the chances to find spermatozoa for ICSI. Some complications may occureven following TEFNA.