Introduction

Microdissection testicular sperm extraction (mTESE) is considered the gold standard for the retrieval of sperm in men with non-obstructive azoospermia with success rates approaching 50%. However a significant proportion of couples wish to be considered for repeat attempts at sperm retrieval. The aim of this study was to determine the rates of success at our centre.

Methods

Twenty-three patients with non-obstructive azoospermia were identified from a prospective database between 2011 and 2016. All had undergone previous unsuccessful mTESE with testis biopsy. Data on hormonal profile and testis pathology were collected. Twenty-two men were started on hormonal manipulation prior to a repeat mTESE.

Results

Overall the mean age of men identified was 37.8 years. The commonest pathological findings from first testis biopsy were maturation arrest (n=11) and Sertoli cell only syndrome (n=7). Twelve men had normal testosterone when started on hormonal manipulation. The success rate of repeat mTESE was 35% (n=8). Three men with initial negative mTESE underwent varicocelectomy and hormone treatment prior to successful repeat mTESE. Maturation arrest was more common in the failure group (n=9; 60%) compared with the success group (n=2; 25%).

Conclusions

There is limited evidence on the utility of repeat mTESE in men who have previously failed the same procedure. Hormonal manipulation may increase the chance of surgical sperm retrieval. Our data suggests that it is worthwhile repeating mTESE with hormonal manipulation however, counselling of these patients remains vitally important.

Funding

None