Background: The purpose of the study was to investigate whether micro-TESE can improve sperm retrieval rate
(SRR) compared to conventional single TESE biopsy on the same testicle or to contralateral multiple TESE, by
employing a novel stepwise micro-TESE approach in a population of poor prognosis patients with non-obstructive
azoospermia (NOA).
Methods: Sixty-four poor prognosis NOA men undergoing surgical testicular sperm retrieval for ICSI, from March
2007 to April 2013, were included in this study. Patients inclusion criteria were a) previous unsuccessful TESE, b)
unfavorable histology (SCOS, MA, sclerahyalinosis), c) Klinefelter syndrome. We employed a stepwise micro-TESE
consisting three-steps: 1) single conventional TESE biopsy; 2) micro-TESE on the same testis; 3) contralateral multiple
TESE.
Results: SRR was 28.1 % (18/64). Sperm was obtained in both the initial single conventional TESE and in the
following micro-TESE. The positive or negative sperm retrieval was further confirmed by a contralateral multiple
TESE, when performed. No significant pre-operative predictors of sperm retrieval, including patients’ age, previous
negative TESE or serological markers (LH, FSH, inhibin B), were observed at univariate or multivariate analysis.
Micro-TESE (step 2) did not improve sperm retrieval as compared to single TESE biopsy on the same testicle
(step 1) or multiple contralateral TESE (step 3).
Conclusions: Stepwise micro-TESE could represent an optimal approach for sperm retrieval in NOA men. In
our view, it should be offered to NOA patients in order to gradually increase surgical invasiveness, when
necessary. Stepwise micro-TESE might also reduce the costs, time and efforts involved in surgery