To enhance testicular function and raise the possibility of sperm retrieval, azoospermic men with varicocele frequently undergo varicocele microligation. Fine-needle aspiration (FNA) mapping biopsy can be used to locate remaining foci of spermatogenesis in cases where initial microdissection testicular sperm extraction (mTESE) is unsuccessful. We report a 33-year-old man with persistent azoospermia 1 year after varicocele microligation and failed mTESE. Multiple locations containing sperm were found in both testes using FNA mapping; the majority of the sperm that were recovered were immotile sperm, which were later judged unsuitable for use in an in vitro fertilization/intracytoplasmic sperm injection program. This case illustrates that FNA mapping can reveal discrete areas of residual spermatogenesis even after repeated unsuccessful mTESE, although the functional quality of retrieved sperm may limit its clinical utility.
azoospermia ; fine-needle biopsies ; male infertility ; sperm retrieval

The use of fresh versus frozen spermatozoa in men with nonobstructive azoospermia (NOA) undergoing in vitro fertilization (IVF) has been a debated hot topic among reproductive specialists. Each approach presents distinct advantages and disadvantages, with fresh sperm typically showing superior sperm quality, while frozen sperm offers logistical flexibility and a reliable backup for repeated cycles. This review summarizes the latest advancements in sperm retrieval and cryopreservation techniques, providing practitioners with a comprehensive analysis of each option's strengths and limitations. Comparative studies indicate that, although fresh sperm often has better quality metrics, cryopreservation methods such as vitrification have significantly improved postthaw outcomes, making frozen sperm a viable choice in assisted reproductive technologies (ART). The findings show comparable rates for fertilization, implantation, clinical pregnancy, and live birth between fresh and frozen microdissection testicular sperm extraction (micro-TESE) sperm in many cases, although patient-specific factors such as timing, cost-effectiveness, and procedural convenience should guide the final decision. Ultimately, the choice of using fresh or frozen sperm should align with the individual needs and conditions of patients. This tailored approach, supported by the latest advancements, can optimize ART outcomes and provide personalized reproductive care.
Humans ; Cryopreservation/methods* ; Male ; Sperm Retrieval ; Semen Preservation/methods* ; Azoospermia/therapy* ; Pregnancy ; Female ; Fertilization in Vitro ; Spermatozoa ; Microdissection ; Pregnancy Rate