Testicular biopsy can be part of intracytoplasmic sperm injection (ICSI) treatment in patients with clinical evidence of NOA(Nonobstructive Azospermi). Testicular sperm extraction (TESE) is the technique of choice. Spermatogenesis may be focal, which means that in about 50% of men with NOA, spermatozoa can be found and used for ICSI. Most authors, therefore, recommend taking several testicular samples. There is a good correlation between the histology found upon diagnostic biopsy and the likelihood of finding mature sperm cells during testicular sperm retrieval and ICSI. However, no threshold value has been found for FSH, inhibin B, or testicular volume and successful sperm harvesting. When there are complete AZFa and AZFb microdeletions, the likelihood of sperm retrieval is virtually zero. Microsurgical TESE increases retrieval rates vs. conventional TESE and should be preferred in severe cases of non-obstructive azoospermia. Positive retrievals are reported even in conditions such as Sertoli cell-only syndrome type II.
The results of ICSI are worse when using sperm retrieved from men with NOA compared to sperm from ejaculated semen and from men with obstructive azoospermia (OA). Birth rates are lower in NOA vs. OA (19% vs 28%).
ICSI results in significantly lower fertilization and implantation rates.
Neonatal health in terms of birth parameters, major anomalies, and chromosomal aberrations in a large cohort of children born after the use of non-ejaculated sperm is comparable to the outcome of children born after use of ejaculated sperm.