Objective: To evaluate various methods of operative sperm retrieval in men with non-obstructive azoospermia (NOA) and to determine the optimal surgical approach in terms of effectiveness, morbidity, and complications.
Materials and methods: PubMed and Cochrane databases were searched to identify five recent reviews and meta-analyses evaluating outcomes for sperm retrieval in men with NOA.
Results and conclusion: Micro-TESE is the most efficient method for retrieving sperm but requires special expertise and can be traumatic for the testes. Conventional biopsies are twice more likely to retrieve sperm than fine-needle aspiration. Testicular aspiration performed by multiple passes into the testis is traumatic and is not efficient for sperm retrieval. Needle-aspiration biopsy and open real-time testicular mapping by the single seminiferous tubule technique can offer less traumatic methods for sperm retrieval, which can be tried before proceeding to micro-TESE. The first attempt at sperm retrieval is the best chance the patient has and should combine various techniques sequentially to give the highest chance of success with the least morbidity.
Keywords: (N)OA, (non-)obstructive azoospermia; (O)FNA, (open) fine-needle aspiration; (c) (micro-) (n) TESE, (conventional) (microdissection) (needle) testicular sperm extraction; AZF(a)(b)(c), azoospermia factor (a) (b) (c); ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilisation; MeSH, medical subject heading; NAB, needle aspiration biopsy;; Non-obstructive azoospermia; Operative sperm retrieval; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; SRR, sperm retrieval rate; SSSSR, single-session staged sperm retrieval; SST, single seminiferous tubule; TESA, testicular sperm aspiration; Testicular failure; Testicular sperm extraction.