P-071 Sperm extraction outcomes in microsurgical Testicular Sperm Extraction (microTESE), TESE and Testicular Sperm Aspiration (TESA) and their association with testes volume and serum FSH level

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Abstract Study question Is microsurgical Testicular Sperm Extraction (microTESE) superior to TESE and Testicular Sperm Aspiration (TESA) in patients with Non-Obstructive Azoospermia (NOA)? Summary answer Globally, higher motility rate and more aliquots were achieved with microTESE. At testicular volume>8 ml or FSH>15IU\L spermatozoa retrieval rates were also higher with microTESE. What is known already Patients with NOA are sterile unless viable sperm suitable for intracytoplasmic sperm injection (ICSI) is retrieved by one of the testicular sperm retrieval techniques. In contrast to TESE and TESA, microTESE suggests an attractive method to identify under microscopic vision candidate isolated regions of spermatogenesis within the testis. Despite that, the question whether microTESE is superior to TESE or TESA is still debatable, with conflicting results in published studies. Study design, size, duration A cohort study reviewing operation, histopathology and fertility records of all NOA patients who underwent their first testicular sperm retrieval at a single tertiary center, between 2002-2023, in the same IVF laboratory using the same protocol. Histological samples were examined at the center’s pathology department Participants/materials, setting, methods The study group included 209 NOA patients who had their first surgery for sperm retrieval. Patients with prior testicular operations were excluded. Clinical characteristics and sperm retrieval outcomes were compared between microTESE, TESE, and TESA, including sub-group analysis for testicular volume and FSH level Main results and the role of chance Baseline characteristics were similar between the microTESE (n = 87), TESE (n = 41) and TESA (n = 81) groups. Despite a higher rate of rate of Sertoli cell only histopathological diagnosis in the microTESE group (62%vs. 45% and 48% p = 0.028), the sperm retrieval rates (SRR) showed a trend in favor of microTESE, but below statistical significance (57% Vs. 44% in TESE, p = 0.185 and 48% in TESA p = 0.196). In cases in which viable sperm suitable for ICSI was retrieved, microTESE yielded significantly higher rates of motile spermatozoa (40%vs.7% in TESE and 14% in TESA, p < 0.001), and higher number of frozen aliquots (5.7±7.4 Vs. 2.6±3.956 in TESE (p = 0.0238) and 3.1±3.9 in TESA (p = 0.0356)). In a sub-group analysis of patients with testicular volume> 8 ml (n = 79), SRR was significantly higher following microTESE (53% Vs. 28% and 35% respectively, p = 0.05). Similarly, in a sub-group analysis of patients with FSH levels >15 IU\L (n = 124), SRR was significantly higher following microTESE compared to TESE (54% Vs. 23%, p = 0.013). Moreover, in 28% of microTESE patients, sperm was found quickly enough to avoid operating the second testis and allowing a one-sided operation, compared to 18% of TESE and 7% of TESA patients (p = 0.003). Limitations, reasons for caution Retrospective design in which different surgical sperm retrieval procedures were chosen in accordance to individual clinical considerations. Nevertheless, in this cohort microTESE was found to be superior in many aspects, despite the fact that more patients in this group had an unfavorable testicular histology. Wider implications of the findings MicroTESE is advantageous in terms of sperm motility, quantitative product and surgical unilaterality in all NOA patients. SRR seems to be higher with microTESE, especially in patients with higher testicular volume(> 8ml) or high FSH levels(>15 IU\L), suggesting that microTESE should be the first line procedure in these cases. Trial registration number No

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