Role of tissue digestion and extensive sperm search after microdissection testicular sperm extraction.

Objective: To report the chance of sperm discovery in the laboratory when sperm were not identified in the operating room (OR).

Design: Clinical retrospective study.

Setting: Department of urology at a tertiary university hospital.

Patient(s): A total of 1,054 men with nonobstructive azoospermia who underwent microdissection testicular sperm extraction.

Intervention(s): Preoperative and intraoperative parameters were analyzed relative to the chance of sperm identification using a tissue digestion protocol in the laboratory if no sperm were observed in the OR.

Main Outcome Measure(s): Sperm retrieval, clinical pregnancy, and live birth rates.

Result(s): Sperm were found in the OR in 52.5% of the 1,054 men. Of the 501 men for whom sperm were not identified by andrologists in the OR, sperm were found in the laboratory for an additional 35 (7%). On multivariable logistic regression analysis, the presence of germ cells intraoperatively was the only predictor of identifying sperm in the laboratory after tissue digestion.

Conclusion(s): In men undergoing microdissection testicular sperm extraction, when sperm were not observed in the OR despite extensive mechanical processing, sperm were observed in the laboratory for 7% of the men. This information is valuable in counseling couples in the immediate postoperative period when no sperm were identified intraoperatively.