Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 31;12(7):1062-1070.
doi: 10.21037/tau-23-76. Epub 2023 Jul 10.

Factors associated with undergoing microdissection testicular sperm extraction among men with non-obstructive azoospermia following evaluation by a reproductive urologist

Daniel R Greenberg #  1 , Alexander V Stanisic #  2 , Minh N Pham  1 , Matthew T Hudnall  1 , Siddhant S Ambulkar  2 , Robert E Brannigan  1 , Richard J Fantus  3 , Joshua A Halpern  1
Affiliations

Factors associated with undergoing microdissection testicular sperm extraction among men with non-obstructive azoospermia following evaluation by a reproductive urologist

Daniel R Greenberg et al. Transl Androl Urol. .

Abstract

Background: Microdissection testicular sperm extraction (mTESE) is the gold standard treatment for men with non-obstructive azoospermia (NOA). However, many men do not elect to pursue this surgical intervention. We aimed to identify factors associated with NOA patients undergoing mTESE after initial evaluation by a reproductive urologist (RU) through a retrospective cohort study.

Methods: We retrospectively reviewed NOA patient who underwent evaluation by a RU between 2002-2018. Demographic and clinical data were collected. Our primary outcome was electing to undergo mTESE.

Results: 44.4% (75/169) of NOA men underwent mTESE. These patients earned significantly higher median neighborhood income ($133,000 vs. $97,000, P<0.001), spent fewer years trying to conceive before seeking care {1.3 [interquartile range (IQR): 1-3] vs. 2.3 (IQR: 1-5), P=0.012}, and were more likely to be married (79.7% vs. 53.9%, P=0.001). On univariate analysis, married men [odds ratio (OR) 3.37, 95% confidence interval (CI): 1.67-6.79, P=0.001] and men with higher neighborhood income (OR 1.14, 95% CI: 1.06-1.21, P<0.001) were more likely to undergo mTESE, while couples attempting to conceive for a longer period of time prior to initial evaluation were less likely to undergo mTESE (OR 0.79, 95% CI: 0.68-0.92, P=0.003). On multivariable regression analysis, marital status and years attempting to conceive remained significantly associated with NOA patients undergoing mTESE (OR 4.61, 95% CI: 1.16-18.25, P=0.03; OR 0.67, 95% CI: 0.52-0.88, P=0.003, respectively).

Conclusions: Higher neighborhood income and marital status were positively associated with patients undergoing mTESE, while couples who attempted to conceive for a longer period of time before seeking infertility care were less likely to undergo mTESE.

Keywords: Male infertility; azoospermia; microdissection testicular sperm extraction (mTESE).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-76/coif). The authors have no conflicts of interest to declare.

References

    1. Evers JL. Female subfertility. Lancet 2002;360:151-9. 10.1016/S0140-6736(02)09417-5 - DOI - PubMed
    1. Practice Committee of the American Society for Reproductive Medicine . Electronic address: asrm@asrm. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 2020;113:533-5. 10.1016/j.fertnstert.2019.11.025 - DOI - PubMed
    1. Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989;142:62-5. 10.1016/S0022-5347(17)38662-7 - DOI - PubMed
    1. Schoor RA, Elhanbly S, Niederberger CS, et al. The role of testicular biopsy in the modern management of male infertility. J Urol 2002;167:197-200. 10.1016/S0022-5347(05)65411-0 - DOI - PubMed
    1. Shamohammadi I, Sadighi Gilani M, Kazemeyni SM, et al. Evaluation of azoospermic patients to distinguish obstructive from non-obstructive azoospermia, and necessity of diagnostic testis biopsy. Int J Fertil Steril 2022;16:156-61. - PMC - PubMed