Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia: Testicular histology can predict success of sperm retrieval

Purpose: We present treatment results of testicular sperm extraction with i ntracytoplasmic sperm injection for men with nonobstructive azoospermia and reevaluate the role of testicular histology on open diagnostic testicular biopsy as a predictor of sperm retrieval success. Materials and Methods: We evaluated 75 men diagnosed with nonobstructive az oospermia. Cases were categorized into 3 groups of hypospermatogenesis, mat uration arrest or Sertoli-cell-only based on the most advanced pattern of s permatogenesis seen on histology. A total of 81 testicular sperm extraction s with intracytoplasmic sperm injection were performed for these 75 men. Th e main outcome measures reviewed included sperm retrieval, fertilization an d pregnancy rates with intracytoplasmic sperm injection. Sperm retrieval su ccess rates for men in the 3 histological categories were compared. Results: Spermatozoa were successfully retrieved during 47 of 81 (58%) test icular sperm extraction attempts, with subsequent fertilization of 268 of 4 39 (61%) injected metaphase II oocytes using intracytoplasmic sperm injecti on. Clinical pregnancies were obtained in 26 of 47 (55%) cycles when sperm were retrieved, with ongoing pregnancies or live deliveries for 20 of 47 (4 3%). Of 39 men with hypospermatogenesis on diagnostic biopsy 31 (79%) had s uccessful sperm retrieval, compared to 9 of 19 (47%) with maturation arrest and 5 of 21 (24%) with a pure Sertoli-cell-only pattern. Conclusions: Critical examination of the most advanced pattern of spermatog enesis from open diagnostic testis biopsy allows prediction of sperm retrie val success with testicular sperm extraction. In this study population sper matozoa were retrieved in 58% of attempts. When this testicular sperm was u sed with intracytoplasmic sperm injection clinical pregnancy rate was 55% f or men with nonobstructive azoospermia.