Fertility potential in azoospermic men presenting with bilateral undescended testis using inguinal MicroTESE: A real world data of Indian population

Objective To evaluate sperm retrieval outcomes using microdissection testicular sperm extraction in azoospermic men with untreated undescended testes presenting in adulthood.Design Retrospective observational study.Subjects Twenty azoospermic adult men diagnosed with undescended testes and no prior history of corrective testicular surgery were included in this single-center study.Exposure Patients underwent hormonal evaluation, imaging for localization of undescended testes, and microdissection testicular sperm extraction. Intraoperative testicular biopsies were performed to evaluate potential malignancy. All included patients had bilateral untreated undescended testes and none had undergone prior orchidopexy or corrective testicular surgery before MicroTESE.Main outcome measure Primary outcome was successful surgical sperm retrieval. Secondary measures included hormonal profile, testicular location, and testicular volume.Results The mean age of participants was 31.7 years (range, 22–46 years). Hormonal evaluation demonstrated elevated follicle-stimulating hormone and luteinizing hormone levels with low-normal testosterone levels, consistent with primary testicular failure. Eighteen patients had inguinal testes, and two had abdominal testes. Testicular volumes ranged from 1.4 to 14.6 cubic centimeters. Sperm retrieval was successful in 11 of 20 patients (55%). All successful retrievals occurred in patients with inguinal testes, corresponding to a retrieval rate of 61.1% (11 of 18), whereas no sperm was retrieved in patients with abdominal testes.Conclusion Microdissection testicular sperm extraction is an effective fertility treatment option for azoospermic men with undescended testes presenting in adulthood, particularly when testes are located in the inguinal region. Testicular location appears to significantly influence sperm retrieval outcomes. These findings support offering surgical sperm retrieval even in previously untreated adult patients with undescended testes.