Testicular tumor is the most common solid malignancy in males under 40 years of age. This malignancy is known to have a negative impact on male fertility. Therefore, several techniques for sperm retrieval have been proposed, including microdissection testicular sperm extraction (mTESE). The objective of this study was to review the literature on the outcomes of oncological (Onco)-mTESE at the time of radical orchiectomy. We conducted a comprehensive literature search through PubMed, Scopus, and Cochrane Central Controlled Register of Trials. Only studies reporting ex vivo mTESE in patients with testicular tumor were considered. Twelve papers met the inclusion criteria and were included in this review. Tumor size was identified as the sole preoperative factor influencing spermatogenesis. The considered studies demonstrated a satisfactory success rate for Onco-mTESE, associated with a similarly valid percentage of live healthy births through assisted reproductive technology. Currently, no comparison has been made between Onco-mTESE and conventional Onco-TESE, hence further assessment is required. In cases where the tumor completely replaces the cancer-bearing testicle, a contralateral micro-TESE may be a viable alternative. However, the surgeon should evaluate associated risks and benefits preoperatively. In conclusion, Onco-mTESE at the time of radical orchiectomy appears to be a promising therapeutic option for young patients with testicular tumors. Nevertheless, additional studies are necessary to achieve a definitive conclusion.
Humans ; Male ; Azoospermia/etiology* ; Sperm Retrieval ; Orchiectomy/methods* ; Testicular Neoplasms/complications* ; Microdissection/methods* ; Testis/surgery* ; Adult

When microdissection testicular sperm extraction (micro-TESE) fails, a redo procedure may be the only option for patients who want a biological child. However, there are many gaps of knowledge surrounding the procedure, which need to be addressed to help clinicians and patients make informed decisions. This review explores redo micro-TESE in the context of nonobstructive azoospermia (NOA). Literature was searched using Google Scholar, Medline, and PubMed. Search terms were "NOA" AND "second microdissection testicular sperm extractions" AND "redo microdissection testicles sperm extraction" AND "repeat microdissection testicular sperm extractions" AND "failed microdissection testicular sperm extractions" AND "salvage microdissection testicular sperm extractions". Only original articles in English were included. A total of nine articles were included, consisting of four retrospective and five prospective studies. The time gap between the first and second micro-TESE varied from 6 months to 24 months. Most of the included studies reported successful surgical sperm retrieval (SSR) in the second micro-TESE in the range of 10%-21%, except in one study where it reached 42%. It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE. Patients with hypospermatogenesis and Klinefelter syndrome (KS) had the highest chance of success in redo surgery. In conclusion, redo micro-TESE following a negative procedure can lead to sperm recovery in 10%-21%. Patients with hypospermatogenesis and KS have a higher chance of success. There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.
Humans ; Male ; Azoospermia/surgery* ; Sperm Retrieval ; Microdissection ; Reoperation ; Treatment Failure ; Testis/surgery* ; Treatment Outcome

Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.
Humans ; Azoospermia/surgery* ; Male ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Treatment Outcome ; Testis/pathology* ; Female ; Microdissection

Nonobstructive azoospermia (NOA) is considered the most challenging clinical scenario for infertile men and current treatments leave many men unsuccessful at being able to achieve a pregnancy with their partner using their own sperm. Microdissection testicular sperm extraction (micro-TESE) is the choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection. With suboptimal micro-TESE success rates of sperm retrieval and then pregnancy and live birth using the retrieved sperm with in vitro fertilization/intracytoplasmic sperm injection, advances to improve outcomes are necessary. This article comprehensively reviews the technologies investigated to date to improve the outcomes for men undergoing micro-TESE.
Humans ; Male ; Sperm Retrieval ; Azoospermia/surgery* ; Pregnancy ; Female ; Sperm Injections, Intracytoplasmic ; Microdissection/methods* ; Fertilization in Vitro ; Testis/surgery*

To investigate the impact of preoperative serum follicle-stimulating hormone (FSH) levels on the probability of testicular sperm retrieval, we conducted a study of nonobstructive azoospermic (NOA) men with different testicular volumes (TVs) who underwent microdissection testicular sperm extraction (micro-TESE). A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital, Shenzhen, China) were retrospectively reviewed. The subjects were divided into four groups based on average TV quartiles. Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups. Overall sperm retrieval rate was 57.6%. FSH levels (median [interquartile range]) were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was <5 ml (first quartile [Q1: TV <3 ml]: 43.32 [17.92] IU l -1 vs 32.95 [18.56] IU l -1 , P = 0.048; second quartile [Q2: 3 ml ≤ TV <5 ml]: 31.31 [15.37] IU l -1 vs 25.59 [18.40] IU l -1 , P = 0.042). Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were <5 ml (adjusted odds ratio [OR]: 1.06 per unit increase; 95% confidence interval [CI]: 1.01-1.11; P = 0.011). In men with TVs ≥5 ml, larger TVs were associated with lower odds of sperm retrieval (adjusted OR: 0.84 per 1 ml increase; 95% CI: 0.71-0.98; P = 0.029). In conclusion, elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs <5 ml. In men with TV ≥5 ml, increases in average TVs were associated with lower odds of sperm retrieval.
Humans ; Male ; Azoospermia/surgery* ; Sperm Retrieval/statistics & numerical data* ; Adult ; Follicle Stimulating Hormone/blood* ; Retrospective Studies ; Testis/pathology* ; Microdissection ; Organ Size

Infertility, defined as the inability to conceive after 1 year of regular unprotected intercourse, impacts 10%-20% of couples globally. Both male and female factors contribute equally to this condition. Azoospermia, particularly nonobstructive azoospermia (NOA), which affects 10%-15% of infertile men, represents a significant challenge in male infertility. The advent of assisted reproductive technology (ART), specifically microdissection testicular sperm extraction (micro-TESE) followed by intracytoplasmic sperm injection (ICSI), offers a possibility for men with NOA to father biological children. Recent studies have focused on the predictors of sperm retrieval in NOA patients, such as age, testicular volume, and follicle-stimulating hormone (FSH) level. This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE, thereby enhancing understanding and improving outcomes for this challenging condition.
Humans ; Azoospermia/surgery* ; Male ; Testis/pathology* ; Sperm Retrieval ; Scrotum/pathology* ; Sperm Injections, Intracytoplasmic ; Microdissection

Oncological microdissection testicular sperm extraction (onco-micro-TESE) represents a significant breakthrough for patients with nonobstructive azoospermia (NOA) and a concomitant in situ testicular tumor, to be managed at the time of sperm retrieval. Onco-micro-TESE addresses the dual objectives of treating both infertility and the testicular tumor simultaneously. The technique is intricate, necessitating a comprehensive understanding of testicular anatomy, physiology, tumor biology, and advanced microsurgical methods. It aims to carefully extract viable spermatozoa while minimizing the risk of tumor dissemination. This review encapsulates the procedural intricacies, evaluates success determinants, including tumor pathology and spermatogenic tissue health, and discusses the implementation of imaging techniques for enhanced surgical precision. Ethical considerations are paramount, as the procedure implicates complex decision-making that weighs the potential oncological risks against the profound desire for fatherhood using the male gametes. The review aims to provide a holistic overview of onco-micro-TESE, detailing methodological advances, clinical outcomes, and the ethical landscape, thus offering an indispensable resource for clinicians navigating this multifaceted clinical scenario.
Humans ; Male ; Azoospermia/therapy* ; Testicular Neoplasms/pathology* ; Sperm Retrieval ; Microdissection/methods* ; Testis/surgery*

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

To investigate the factors affecting the sperm retrieval rate of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS), 64 patients with nonmosaic KS who underwent micro-TESE in the Center for Reproductive Medicine of Peking University Third Hospital (Beijing, China) between January 2016 and December 2017 were included in the study. Data on medical history, physical examination and laboratory examination results, and micro-TESE outcomes were collected. Patients were divided into two groups according to micro-TESE outcomes. The following factors were compared between the two groups by the Mann‒Whitney U test or Student's t-test based on the distribution (nonnormal or normal) of the factors: age, testicular size, follicle-stimulating hormone level, luteinizing hormone level, testosterone level, and anti-Müllerian hormone level. The overall success rate of sperm retrieval was 50.0%. Correlation analysis showed that testicular volume was positively correlated with testosterone level. Using a logistic regression model, age and anti-Müllerian hormone levels were found to be better predictors for the sperm retrieval rate than the other parameters.
Humans ; Male ; Sperm Retrieval ; Klinefelter Syndrome ; Microdissection ; Anti-Mullerian Hormone ; Semen ; Testis ; Spermatozoa ; Testosterone ; Azoospermia ; Retrospective Studies

Azoospermia/therapy* ; Female ; Humans ; Male ; Microdissection ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic ; Sperm Motility ; Sperm Retrieval ; Spermatozoa ; Testis