Delayed Detection of Sperm in the Ejaculate Following Failed Microdissection Testicular Sperm Extraction in a Man With Azoospermia: A Case Report
Case Report
DOI:
https://doi.org/10.55175/cdk.v53i09.2239Keywords:
Azoospermia, case report, microdissection testicular sperm extraction, mTESE, non-obstructive azoospermia, sperm retrievalAbstract
Introduction: Non-obstructive azoospermia (NOA) affects 10%–15% of infertile males, posing a significant challenge in fertility management. Microdissection testicular sperm extraction (mTESE) is regarded as the gold standard for sperm retrieval for NOA. However, even when mTESE fails to retrieve sperm, unexpected postoperative findings may still occur. Case: A 31-year-old male with primary infertility and azoospermia underwent two surgical sperm retrieval procedures: percutaneous epididymal sperm aspiration (PESA) and mTESE. Hormonal and genetic evaluations revealed no abnormalities, but no sperm were retrieved during either procedure. Remarkably, six days after surgery, a self-ejaculated sample yielded five motile spermatozoa, which were immediately cryopreserved for intracytoplasmic sperm injection. Histopathology indicated moderate spermatogenesis with Johnsen scores of 6.0 and 7.0 for the right and left testes, respectively, highlighting residual spermatogenic activity. Discussion: The postoperative appearance of spermatozoa may reflect focal or intermittent spermatogenesis that was not detected during surgical sampling. The histopathological findings support the presence of limited residual sperm production despite unsuccessful PESA and mTESE. Conclusion: The detection of motile spermatozoa after failed mTESE highlights the importance of postoperative for follow-up, repeated semen analysis, and timely cryopreservation in the fertility management of patients with NOA.
Downloads
References
Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics. 2013;68 Suppl 1(Suppl 1):15–26. doi: 10.6061/clinics/2013(sup01)03.
Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14(1):131–5. doi: 10.1093/humrep/14.1.131.
Colpi GM, Caroppo E. Performing microdissection testicular sperm extraction: surgical pearls from a high-volume infertility center. J Clin Med. 2021;10(19):4296. doi: 10.3390/jcm10194296.
Zhang F, Dai M, Yang X, Cheng Y, Ye L, Huang W, et al. Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non-obstructive azoospermia: a systematic review and meta-analysis. Andrology. 2024;12(1):30–44. doi: 10.1111/andr.13448.
Vahidi S, Horoki AZ, Talkhooncheh MH, Jambarsang S, Marvast LD, Sadeghi A, et al. Success rate and ART outcome of microsurgical sperm extraction in non-obstructive azoospermia: a retrospective study. Int J Reprod Biomed. 2021;19(9):781–8. doi: 10.18502/ijrm.v19i9.9710.
Dartmouth Health. FSH and LH level. Dartmouth Health laboratory test catalog [Internet]. 2022. Available from: https://one-dh.testcatalog.org/.
Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2014;2(1):20–4. doi: 10.1111/j.2047-2927.2013.00148.x.
Silber SJ, Nagy Z, Devroey P, Tournaye H, Van Steirteghem AC. Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure. Hum Reprod. 1997;12(11):2422–8. doi: 10.1093/humrep/12.11.2422.
Hauser R, Botchan A, Amit A, Yosef DB, Gamzu R, Paz G, et al. Multiple testicular sampling in non-obstructive azoospermia—is it necessary? Hum Reprod. 1998;13(11):3081–5. doi: 10.1093/humrep/13.11.3081.
Yildirim M, Koc A, Kaygusuz IC, Badem H, Karatas OF, Cimentepe E, et al. The association between serum follicle-stimulating hormone levels and the success of microdissection testicular sperm extraction in patients with azoospermia. Urol J. 2014;11(4):1825–8. PMID: 25194084.
Caroppo E, Colpi EM, Gazzano G, Vaccalluzo L, Scroppo FI, D’Amato G, et al. Testicular histology may predict successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. J Assist Reprod Genet. 2017;34(1):149–54. doi: 10.1007/s10815-016-0812-3.
Kim TJ, Koo K. Testosterone to luteinizing hormone ratio as a potential predictor of sperm retrieval in non-obstructive azoospermia patients. Yonsei Med J. 2023;64(7):433–9. doi: 10.3349/ymj.2023.0054.
Xu T, Peng L, Lin X, Li J, Xu W. Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction following failed TESE in nonobstructive azoospermia patients. Andrologia. 2017;49(4):e12642. https://doi.org/10.1111/and.12642.
Talas H, Yaman O, Aydos K. Outcome of repeated microsurgical testicular sperm extraction in patients with non-obstructive azoospermia. Asian J Androl. 2007;9(5):668–73. doi: 10.1111/j.1745-7262.2007.00273.x.
Mangum CL, Patel DP, Jafek AR, Samuel R, Jenkins TG, Aston KI, et al. Towards a better testicular sperm extraction: novel sperm sorting technologies for non-motile sperm extracted by microdissection TESE. Transl Androl Urol. 2020;9(S2):S206–14.
Leung A, Mira J, Hsiao W. Updates on sperm retrieval techniques. Transl Androl Urol. 2014;3(1):94–101. doi: 10.3978/j.issn.2223-4683.2014.02.03.
Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, et al. Sperm recovery and ICSI outcomes in men with nonobstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(6):733–57. doi: 10.1093/humupd/dmz028.
Dafopoulos K, Griesinger G, Schultze-Mosgau A, Orief Y, Schopper B, Nikolettos N, et al. Factors affecting outcome after ICSI with spermatozoa retrieved from cryopreserved testicular tissue in non-obstructive azoospermia. Reprod Biomed Online. 2005;10(4):455–60. doi: 10.1016/s1472-6483(10)60820-6.
Boeri L, Dente D, Greco E, Turetti M, Capece M, Cocci A, et al. P-095 outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed TESE in men with non-obstructive azoospermia: results from a multicenter study. Hum Reprod. 2021;36(Suppl 1):deab130.094. https://doi.org/10.1093/humrep/deab130.094.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Mukhlis Akmal Taher N, Esther Syalomia Silalahi, Fathimah Azzahra, Favian Ariiq, Armand Achmadsyah, Widi Atmoko, Nur Rasyid, Ponco Birowo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
