(685) Testicular Biopsies – The Experience of a Tertiary Center

Introduction Testicular biopsy is indicated in patients with obstructive azoospermia (OA) who are not candidates for reconstructive surgery, as well as in non-obstructive azoospermia (NOA), due to the potential presence of focal spermatogenesis. It is also indicated in cases where sperm cannot be retrieved from ejaculate due to ejaculatory dysfunction or severe sperm motility disorders. Objective To share our institutional experience. Methods Descriptive retrospective study including all patients who underwent testicular biopsy at our hospital center between 01/01/2018 and 31/12/2023. Results A total of 99 testicular biopsies were performed in 82 patients, with a mean age of 35.98 ± 5.04 years. The most frequent semen analysis result was azoospermia (75.3%), followed by teratoasthenozoospermia with oligozoospermia (15.6%), severe oligozoospermia (3.9%), and asthenoteratozoospermia (5.2%). Open testicular biopsies were performed in 55 cases and aspiration biopsies in 44. Sperm retrieval was successful in 70 biopsies (70.7%), with a retrieval rate of 65.5% in open biopsies and 79.5% in aspiration biopsies. Among the patients in whom sperm were retrieved, 13 had elevated FSH levels. In azoospermic patients, the sperm retrieval rate was 63.4%, and in those with NOA it was 51.2%. However, in 32 biopsies (32.3%), the retrieved sperm presented abnormalities in motility or morphology. Among the 29 biopsies in which sperm retrieval was unsuccessful (25 patients), several alterations were identified: chromosomal abnormalities (3 patients with Klinefelter syndrome and 2 with mixed gonadal dysgenesis). Regarding the AZFc region, 1 patient had a partial duplication and another a microdeletion. In terms of hormonal findings, 11 patients had elevated FSH, 4 had normal FSH, and in 3 cases FSH was not assessed. No intraoperative or postoperative complications were reported. A total of 9 pregnancies (1 non-evolutive) were achieved through ART using sperm retrieved from testicular biopsy. Conclusions Testicular biopsy is a simple procedure with a high sperm retrieval rate, even in patients with NOA. Although FSH is a useful predictor of spermatogenesis, elevated levels do not preclude successful sperm retrieval, as demonstrated by our findings. Disclosure No