The Predictive Value of Testicular Fine Needle Aspiration for Sperm Retrieval from the Contralateral Testis – A Prospective Randomized Study

Advances of the last two decadesin the treatment of azoospermic men enabled recovery of testicular spermatozoa and fertilization of the oocytes with ICSI. Since the introduction of the retrieval of testicular sperm by tissue extraction [1,2], ICSI with testicular sperm has become a routine procedure initially for patients with obstructive azoospermia (OA) [1,2], and later for non-obstructive azoospermia (NOA) [3-5]. Several methods have developed for testicular sperm recovery, each with its own pros and cons [6]. Earlier, testicular percutaneous fine needle aspiration (TEFNA) was considered solely for OA patients, whereas testicular sperm extraction (TESE) by open multiple biopsies was reserved for men with NOA due to gonadal failure. In these hyper gonadotrophic azoospermic men the sperm retrieval rate by TESE was around 50%. Later, the use of TEFNA for NOA was introduced by [7] and was shown to be efficient, safe, less invasive and well-tolerated [8]. Since then, the reported recovery rate of testicular sperm with TEFNA which ran as low as 11% [9] and high as 58.5% and 64.7% [7,10], was subjected to much controversy. With a lack of randomized controlled trials to compare the two methods, non-randomized comparative trials provided data which supported the use of TESE for patients with defective spermatogenesis [9,11,12]. For example, Friedler et al. [9] used TEFNA and TESE consecutively in a single session in 37 NOA patients.The reported superiority of TESE over TEFNA (43% vs. 11% retrieval rate) was questioned by others partly because of the fewer puncture sitesper testicle (6 entries) in this study vs. 15-20 entries per testicle in the original Lewin’s report [8].