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. 2025 Dec;11(1):2511449.
doi: 10.1080/20565623.2025.2511449. Epub 2025 May 30.

Predictors of sperm retrieval success in first-time and repeated Micro-TESE for nonobstructive azoospermia

Sulieman Alriyalat  1 , Mohammad Ghassab Deameh  2 , Hamzeh Farraj  1 , Jad Khaled Alsmadi  3 , Baha' Aldeen Bani Irshid  4 , Hammam Abu Rahmeh  5 , Ahmad Khaled Awawdeh  6 , Mohammad Ahmad Mubarak  6 , Ali Fawzey Ababneh  4 , Wa'el Ahmad Bani Amer  4 , Mohammad Al-Zubi  7
Affiliations

Predictors of sperm retrieval success in first-time and repeated Micro-TESE for nonobstructive azoospermia

Sulieman Alriyalat et al. Future Sci OA. 2025 Dec.

Abstract

Introduction: Microdissection testicular sperm extraction (micro-TESE) is the preferred sperm retrieval method, although success rates vary based on factors such as age and hormone levels. We evaluate sperm retrieval outcomes in first-time and repeated micro-TESE, identifying predictors of success to guide clinical management.

Material and methods: Retrospective study analyzed 152 men with nonobstructive azoospermia (NOA) who underwent micro-TESE between 2020 and 2022. Patients were grouped based on sperm retrieval outcomes, and clinical, demographic and hormonal factors were assessed. Comparisons were made between first-time and repeat micro-TESE cases.

Results: Sperm retrieval rate was higher for first-time TESE cases (64.6%) than repeated TESE cases (28.8%, p < 0.01). Repeated TESE cases were older, had higher smoking rates, and exhibited significantly elevated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, with lower total testosterone (p < 0.01). In repeated TESE cases, no significant differences in age, smoking status or hormone levels were found between successful and failed attempts.

Conclusion: First-time micro-TESE users had a significantly higher sperm retrieval rate than those undergoing repeated attempts. Repeated TESE was associated with older age, higher smoking rates and adverse hormonal profiles. Larger studies are needed to validate these findings and optimize patient selection for repeated micro-TESE.

Keywords: Micro-TESE; azoospermia; hormonal preparation; male infertility; sperm retrieval.

Plain language summary

This study evaluates sperm retrieval outcomes in first-time and repeated micro-TESE procedures among men with nonobstructive azoospermia (NOA).The overall sperm retrieval rate was significantly higher in first-time micro-TESE cases compared to repeated procedures (64.6% vs. 28.8%).Repeated micro-TESE cases were associated with older age, higher smoking prevalence, and more adverse hormonal profiles.Klinefelter syndrome and undescended testes were more prevalent in first-time attempts but showed lower retrieval rates in repeated procedures.Some patients achieved successful sperm retrieval on repeat attempts despite prior failures, potentially due to improved hormonal preparation or surgical factors.The study highlights key clinical and hormonal predictors of micro-TESE outcomes and emphasizes the need for individualized patient selection and counseling.

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Conflict of interest statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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