Testicular sperm aspiration in men with presumed non-obstructive azoospermia: Analysis of FSH level as a predictor of successful sperm retrieval

Document Type : Original Article


1 Rush University Medical Center

2 Department of Urology, Rush University Medical Center, Chicago


Objective: To evaluate the sperm-retrieval rate (SRR) of testicular sperm aspiration (TESA) for men with presumed non-obstructive azoospermia (NOA) without prior genetic testing or testicular biopsies and to examine the correlation of successful sperm retrieval and FSH level.
Patients and Methods: The complete records of 148 azoospermic men without clinical evidence of obstructive etiologies who underwent TESA from 1999 – 2016 were reviewed. Preoperative diagnostic biopsies were not obtained and thus men with presumed NOA were defined as having no evidence of obstruction by history or physical examination. Preoperative FSH and testosterone were obtained for all patients. Two subgroups of NOA were evaluated (Group 1 with FSH > 10 IU/L and Group 2 with FSH ≤ 10).
Results: Of our 148 patients, we identified 66 (45%) in Group 1 and 82 (55%) in Group 2. Sperm was successfully obtained from 19/66 (28.7%) in Group 1 and 56/82 (68%) in Group 2. Average FSH for Group 1 and Group 2 were 20.4 (10 -66) IU/L and 4.6 (1.1 – 9.4) IU/L respectively. There were no postoperative adverse events including prolonged pain, infection, hematoma, hydrocele or testicular atrophy.
Conclusion: TESA appears to offer a reasonably high likelihood of viable sperm retrieval in men with NOA. Given the higher level of SRR for men with presumed NOA with normal range of FSH (≤ 10 IU/L), we recommend that TESA should be considered the initial approach to retrieve sperm in this population as it is a quicker, easier, less invasive and likely a less costly approach to micro-TESE.