(504) Testicular Sperm Aspiration or Microdissection-Testicular Sperm Extraction for Men with Intermittent Azoospermia

Introduction As worldwide infertility rates continue to rise, male factor infertility is increasingly recognized as an important contributor to infertility in couples. Among techniques utilized in fertility care, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have become the cornerstone of assisted reproductive technologies. While the use of ejaculate sperm can have positive IVF outcomes, this approach is not used for patients with severe forms of oligozoospermia. Thus, techniques that enhance the successful retrieval of sperm are crucial for achieving positive clinical outcomes. Numerous sperm retrieval techniques, including microdissection testicular sperm extraction (micro-TESE) and testicular sperm aspiration (TESA), have been developed to directly collect the sperm from the testicles. These techniques have shown promising sperm retrieval rates (SRR) and pregnancy success for oligozoospermic males. However, in patients with intermittent azoospermia, defined by alternating absence and presence of sperm in different semen analyses, the optimal sperm retrieval method has yet to be identified. Objective We sought to evaluate and compare sperm retrieval outcomes by TESA and micro-TESE in cryptozoospermic and oligozoospermic men with intermittent azoospermia in order the assess the efficacy of these procedures. Methods We conducted a retrospective study of 49 consecutive testicular sperm retrievals in cryptozoospermic (n=28) and severely oligozoospermic (n=21) men with intermittent azoospermia. The decision to perform a TESA or a micro-TESE was made after thorough discussion of the pros and cons of these procedures with the couple. All cases were performed by a single urologist. Final assessment of sperm recovery was reported either as successful (available sperm for ICSI) or unsuccessful (no sperm for ICSI). Results In our combined cohort, we found no difference in age, hormone levels or sperm motility between men undergoing TESA or micro-TESE. Men in the combined cohort undergoing micro-TESE had significantly lower sperm concentration than TESA (0.085±0.33 vs 0.16±0.20; p=0.0044), but a significantly improved SRR (95% vs 70%, p=0.048). In a subset of men with severe oligozoospermia, there were no significant differences between the two retrieval techniques in hormone levels, semen concentration or motility, nor in SRR (100% vs 78%, p>0.05). Overall, we found no difference in SRR of micro-TESE between cryptozoospermic and severely oligozoospermic men with intermittent azoospermia (93% vs 100%, p>0.05). Conclusions To our knowledge, this represents the first comparison of sperm retrieval techniques in men with intermittent azoospermia. Overall, our data indicate that in men with intermittent azoospermia, micro-TESE offers higher sperm retrieval rates than TESA. However, future studies are needed to further assess success rates in intermittent azoospermic men with cryptozoospermia. Thus, patients with intermittent azoospermia should be counselled on the success rates of these two techniques to inform their decisions. Disclosure No