Identifying Candidates for Limited Dissection at Microdissection TESE.

Identifying Infertile Men Who May be Amenable to a Limited Testicular Dissection at Microdissection Testicular Sperm Extraction

The goal of this retrospective observational study is to learn whether certain clinical characteristics can help predict which infertile men may successfully have sperm retrieved using a less-invasive "mini-incision" version of micro-TESE. The study focuses on men with very low or absent sperm counts (non-obstructive azoospermia, cryptozoospermia, or severe OAT).

The main questions it aims to answer are:

Can sperm be successfully found using only a small, limited-dissection micro-TESE in some men?

Which clinical factors (such as hormone levels or medical history) help identify men who may benefit from this less-invasive approach?

Researchers will compare men who had successful sperm retrieval with the mini-incision alone to men who required a more extensive micro-TESE to see if certain characteristics predict which approach is likely to work.

This retrospective cohort study evaluates whether preoperative clinical characteristics can help identify infertile men who are likely to achieve successful sperm retrieval through a limited-dissection, mini-incision micro-TESE. The stepwise surgical approach begins with a small equatorial incision for targeted micro-biopsies and is expanded only when sperm are not initially identified.

The study includes men who underwent their first micro-TESE at a high-volume fertility center over a 10-year period. All procedures followed a standardized surgical protocol and were performed by a single experienced surgeon, ensuring uniformity in technique.

Clinical data routinely collected before surgery, such as hormone levels, semen parameters, testicular volume, and relevant medical history, were analyzed and compared between men who required only the mini-incision and those who proceeded to an extended dissection. By examining these differences, the study aims to determine whether certain patient characteristics can predict the success with the less-invasive approach.

The findings may help guide pre-surgical counseling and support more tailored surgical planning for men with severe male factor infertility

Inclusion Criteria:

• Patients with cryptozoospermia or non obstructive azoospermia that underwent a micro-TESE

Exclusion Criteria:

• Patients with a potentially reversible cause of cryptozoospermia (i.e., presence of a varicocele, febrile illness, or recent toxin exposure)
• Patients with suspected partial genital tract obstruction (i.e post-vaso-vasostomy, post-vasoepididymostomy, and low volume cryptozoospermia with ejaculatory duct obstruction)
• Patients who have previously undergone a micro-TESE, TESA or TESE procedure