Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro-tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia?

Urology. 2021 Aug;154:164-169. doi: 10.1016/j.urology.2021.04.037. Epub 2021 May 13.


Objectives: To evaluate and compare sperm retrieval outcomes by testicular sperm aspiration (TESA) and micro-dissection testicular sperm extraction (micro-TESE) in non-azoospermic men.

Methods: We conducted a retrospective study of 145 consecutive testicular sperm retrievals in men with cryptozoospermia (n = 56) or severe oligozoospermia (n = 84). The decision to perform a TESA or a micro-TESE was made after thorough discussion of the pros and cons of these procedures with the couple. Final assessment of sperm recovery, on the day of ICSI, was reported either as successful (available sperm for ICSI) or unsuccessful (no sperm for ICSI).

Results: Mean sperm concentration, sperm motility, testicular volume and serum FSH level of men undergoing TESA were not significantly different from those of men undergoing micro-TESE. In men with severe oligozoospermia (<5 million/ml), sperm recovery was successful in 95% (18/19) of those who underwent micro-TESE and in 92% (60/65) of those who underwent TESA (P > 0.05). In men with cryptozoospermia, sperm recovery was successful in 88% (42/48) of men who underwent micro-TESE and 25% (2/8) of men who underwent TESA (P < .001).

Conclusions: These data indicate that in men with severe oligozoospermia, TESA and micro-TESE are equally successful sperm retrieval techniques. However, in men with cryptozoospermia, sperm retrieval rates are significantly higher with micro-TESE than TESA.

MeSH terms

  • Adult
  • Humans
  • Male
  • Microdissection / methods
  • Microdissection / statistics & numerical data*
  • Oligospermia / diagnosis
  • Oligospermia / therapy*
  • Retrospective Studies
  • Severity of Illness Index
  • Sperm Count / statistics & numerical data
  • Sperm Injections, Intracytoplasmic / methods*
  • Sperm Motility
  • Sperm Retrieval / statistics & numerical data*
  • Testis / diagnostic imaging
  • Testis / surgery*
  • Treatment Outcome