Results of Intracytoplasmic sperm injection (ICSI) performed with sperm retrieved by microscopic testicular sperm extraction (m-TESE) in azoospermic patients

The absence of any sperm in the ejaculate is called azoospermia and it is detected in 1% of males and 10-15% of those with infertility complaints. Azoospermia may be due to obstructive (OA) and non-obstructive (NOA) causes. Today, healthy pregnancies can be achieved in azoospermic patients by intracytoplasmic sperm injection (ICSI) performed using sperm retrieved from microscopic testicular sperm extraction (m-TESE). In this study, we examined the sperm retrieval rates with m-TESE in azoospermic patients, the results of ICSI in OA and NOA patients with sperm and the underlying testicular pathologies in patients without sperm. Patients who underwent m-TESE at IVF unit of our hospital between January 2005 and April 2017 were retrospectively reviewed. A total of 342 azoospermic patients (117 OA and 225 NOA cases) with regular follow-up were included in the study. In these cases, sperm retrieval and clinical pregnancy rates after ICSI were compared. Mean duration of infertility was 28.2±7.8 months in the OA group, 34.2±5.4 years in patients, 30.3±2.9 years in spouses. In the NOA group, the mean duration of infertility was 30.3±6.5 months, the mean age of the patients was 35.3±3.4, and the mean age of the spouses was 30.6±3.3 years. In 68.9% of the cases, the therapeutic indication was male factor alone, while 31.1% had female factor infertility. In the OA group, 68.9% of the cases had only male factor infertility, while 31.1% of them had also female factor infertility. In the NOA group, 65.4% of the cases had only male factor infertility, and female factor was found in 34.6% of the cases. OA patients had a mean serum FSH level of 11.7±3.7 mIU/mL and mean testicular volume of 12.5±2.6 mL, NOA patients had a mean serum FSH level of 13.7±5.4 mIU/mL and mean testicular volume of 9.8±3.4 mL. In the m-TESE procedure, motile sperm was found in all of the OA patients and in 52.4% (118/225) of the NOA patients. Clinical pregnancy rate in the OA group was 29.9% (35/117) and live birth rate was 25.6% (30/117). In the NOA group, the clinical pregnancy rate was 27.1% (32/118) and the live birth rate was 23.7% (27/118). Histopathologic evaluation was made in 107 cases in the NOA group with no testicular sperm, revealing that 59 cases with germ-cell aplasia (sertoli-cell only syndrome), 42 cases with maturation arrest, and 6 cases with hypospermatogenesis. Postoperative hematoma developed in 3 of m-TESE cases and subsided with conservative treatment. If motile sperm is retri