Extended sperm preparation: an alternative to testicular sperm extraction in non-obstructive azoospermia

Testicular sperm retrieval for the treatment of non-obstructive azoospermiarequires the execution of an invasive procedure, with all its possibleattending complications and subsequent long-term effects. This studysuggests a new non-invasive approach for collection of spermatozoa in thesepatients: the extended sperm preparation (ESP). ESP consists of conductinga thorough microscopic search through many droplets of ejaculate sediment.ESP was performed for 49 patients; in 17 patients (35%), spermatozoa werefound and subsequently used in intracytoplasmic sperm injection (ICSI). Ofthese preparations, five yielded fewer motile spermatozoa than the numberof corresponding oocytes available, and in one patient only non-motilespermatozoa were recovered. The remaining 32 ESP-negative patientsunderwent testicular sperm extraction (TESE) from testicular biopsy.Spermatozoa were found in 16 of 32 biopsies (50%) and subsequently used inICSI. Fertilization and cleavage rates were comparable in both ESP and TESEgroups, yielding four clinical pregnancies in each group (27 and 29%respectively). Embryo morphology was defined as excellent in significantlymore cases in the ESP group than the TESE group, and implantation rateappeared somewhat higher in the ESP group (16%) than the TESE group (13%).The ESP technique yields results similar to TESE, and can be applied incases of non-obstructive azoospermia as a prerequisite modality enabling usto avoid testicular biopsy in 35% of cases.