Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction

Objective To report the chance of sperm discovery in the laboratory when sperm were not identified in the operating room (OR). Design Clinical retrospective study. Setting Department of urology at a tertiary university hospital. Patient(s) A total of 1,054 men with nonobstructive azoospermia who underwent microdissection testicular sperm extraction. Intervention(s) Preoperative and intraoperative parameters were analyzed relative to the chance of sperm identification using a tissue digestion protocol in the laboratory if no sperm were observed in the OR. Main Outcome Measure(s) Sperm retrieval, clinical pregnancy, and live birth rates. Result(s) Sperm were found in the OR in 52.5% of the 1,054 men. Of the 501 men for whom sperm were not identified by andrologists in the OR, sperm were found in the laboratory for an additional 35 (7%). On multivariable logistic regression analysis, the presence of germ cells intraoperatively was the only predictor of identifying sperm in the laboratory after tissue digestion. Conclusion(s) In men undergoing microdissection testicular sperm extraction, when sperm were not observed in the OR despite extensive mechanical processing, sperm were observed in the laboratory for 7% of the men. This information is valuable in counseling couples in the immediate postoperative period when no sperm were identified intraoperatively.