Follow up of Patients with non Obstructive Azoospermia who Failed to Retrieve Sperm after TESE

Introduction: The development of an open testicular biopsy used for sperm retrieval is one of the biggest revolutions in the fertility field in the last two decades, allowing azoospermic men to become biological fathers. However, 50- 60% of non obstructive azoospermia (NOA) patients who undergo Testicular Sperm Extraction (TESE) or Micro-TESE are unsuccessful and remain with the dilemma which option to use.

Aim: To follow up NOA patients with failure to retrieve sperm with TESE, Micro TESE.

Materials & Methods: A cohort study of NOA patients in our center who underwent TESE or Micro-TESE with no retrieved sperm between1995 and 2012 was revised. After excluding all patients who succeeded to retrieve sperm in their repeated trial or patients with missing data, 254 couples were recruited to fulfill a telephone questionnaire. Ninety three couples were agreed to complete the questionnaire.

Results: Thirty three (35.5%) couples used sperm donor (SD) as backup in their TESE procedure. Another 19 (20.4%) couples used sperm donor, as mode of treatment, later on. The 52 (55.9%) patients who used SD, classified themselves by their own religious definition.  Among the 32 couples who defined themselves as orthodox Jews, seven (21.8%) used SD; among the 26 couples considered as religious Jews, 15 (57.7%) used SD, whereas the 12 couples who defined themselves as traditional Jews, 10 (83.3%) used SD. All 18 non religious couples used SD. One of the four Moslem couples and the single Christian couple also used SD. Three couples divorced when sperm retrieval failed, 13 couples (14%) chose to adopt a child and two decided to foster a child. 16 of the patients repeated TESE treatments in other medical centers. Some couples used more than one option. 30 couples out of the 93 (32.3%) chose no further treatment.