Full search standard
Spermatogenesis in non-obstructive azoospermia is unevenly distributed, and the second testicle may contain sperm when the first is “empty”. Therefore, if the result is negative in the first testicle (after examining the entire parenchyma), the surgeon immediately moves on to the second; when found in the first testicle, the second is sometimes also examined in order to obtain more material for cryopreservation. Both operations are performed through separate incisions in the scrotum during one anesthesia. Testosterone levels after surgery are monitored after 3–6 months, since with small testicular volume a temporary decrease is possible.
When is sperm retrieval needed?
With azoospermia - the absence of sperm in the ejaculate - conception is possible through IVF-ICSI, for which sperm are obtained surgically. In the obstructive form (patency is impaired, spermatogenesis is preserved), they are aspirated from the epididymis (MESA) with a success rate of more than 95%. In the non-obstructive form (spermatogenesis itself is impaired), foci of preserved spermatogenesis are looked for under a microscope inside the testicle (Micro-TESE) - sperm are found in 40–60% of men, including those with Klinefelter syndrome and after chemotherapy.
Results and cryopreservation
The resulting sperm are either immediately used to fertilize the partner’s eggs (the operation is synchronized with follicle puncture), or are frozen in a cryobank for future IVF cycles. The embryologist evaluates the material directly in the operating room. Complications are rare: hematoma, temporary pain; testicular function after Micro-TESE is preserved thanks to gentle microsurgical techniques.
