Learning curves of microdissection testicular sperm extraction for nonobstructive azoospermia

Objectives Microdissection testicular sperm extraction (micro-TESE) has been performed at some experienced male infertility centers. Micro-TESE in patients with nonobstructive azoospermia (NOA) has been shown to be not only feasible and safe but also a technically demanding operation. To evaluate whether the improvement of surgical outcomes of micro-TESE, we hereby report the learning curves of micro-TESE for NOA patients. Design Retrospective clinical analysis. Setting Male infertility center. Patient(s) Since 2006, micro-TESE was performed in 150 patients with NOA by a single surgeon. Intervention(s) After the tunica albuginea was opened, direct examination of the testicular parenchyma was performed at ×25 magnification. Main Outcome Measure(s) Sperm retrieval rate and clinical factors in the first 50 patients (group A), the middle 50 patients (group B), and the last 50 patients (group C) were examined. Result(s) There were no differences in clinical factors among the three groups. Total operation times were shorter in group B and C than in group A ( P < 0.05). The sperm retrieval rate in group B (44%) and C (48%) was significantly higher than in group A (32%; P < 0.05). Conclusion(s) As cases increase, surgical outcomes and sperm retrieval rate have improved. We think that this report showed substantial learning curves for a microscopic surgery such as micro-TESE.