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Extensive research has been conducted in search of factors that can predict the likelihood of successful testicular sperm retrieval in nonobstructive azoospermia patients. Clinical factors such as patient age, testicular volume, presence of varicocele, cryptorchidism, and Klinefelter syndrome; laboratory factors such as serum FSH level, inhibin B level, and presence of genetic disturbances; and the histopathologic pattern of testicular tissue have all been investigated in the literature. Of all the above-mentioned factors, the histopathologic pattern appears to be most influential in predicting surgical sperm retrieval outcome.
Sperm retrieval and intracytoplasmic sperm injection (ICSI) has become the natural treatment for couples with azoospermia-related infertility, and nowadays is also used for nonazoospermic indications. An increasing body of evidence overwhelmingly based on cohort studies has indicated that ICSI with ejaculated sperm of poor quality negatively affects the chances of assisted conception. Collectively, these data suggest that ICSI with testicular sperm is superior to ICSI with ejaculated sperm as a method of fertilization to overcome sperm DNA fragmentation-related infertility. The candidates are men with high sperm DNA damage in semen and those with severe oligozoospermia or cryptozoospermia. In these patients, percutaneous and open sperm retrieval are highly successful to harvest sperm, with few complications. Current evidence suggests the safe utilization of testicular sperm for ICSI in nonazoospermic men. Further research is warranted to confirm the clinical utility of this approach as a routine ART treatment.
The development of surgical sperm retrieval procedures can be considered as the single most important breakthrough in the field of male infertility. Various testicular sperm retrieval procedures exist and are indicated in patients with obstructive and nonobstructive azoospermia, as well as patients with high levels of sperm DNA fragmentation and severe derangements in semen parameters. Microsurgical testicular sperm extraction can be considered the gold standard retrieval method as it allows meticulous and selective sampling of sperm-containing seminiferous tubules, yielding the highest retrieval rate in comparison to other surgical sperm retrieval methods.