Complex and time-consuming laboratory modifications are not always necessary to improve outcome

quality spermatozoa, this proportion still remains significant, and one can obviously not guarantee that the sperm cell used for ICSI is euploid. Moreover, the technics used in these papers suffer from some limitations and standardization is lacking. Finally, despite the wide use of ICSI for nearly two decades, and without questioning its interest in male infertility, there is still some concern about the health of children born after ICSI. Future developments of sperm preparation technics should focus on associating high cellular retrieval rate and selecting competent and high quality sperm for ICSI, in order to improve both the safety and the success rate of NOA care. Second, and besides these technical considerations, this work raises a few questions on NOA clinical management. First, and prior to performing TESE, NOA patients should obviously be informed on their chances of successful sperm extraction. Unfortunately, the existing noninvasive clinical and biological predictive factors of residual spermatogenesis suffer from relatively poor performance. Age, testicular volume, hormonal markers, such as follicle-stimulating hormone, luteinizing hormone, testosterone, inhibin B, anti-Mullerian hormone have been evaluated, but with limited predictive interest.4 Seminal plasma was also tested as a source for noninvasive evaluation of spermatogenesis. Several seminal markers have thus been proposed for evaluating the chance of successful surgical sperm retrieval, but none of these seminal markers was identified as a relevant prognostic marker for TESE in NOA patients, even if recent developments in proteomics might revolutionize this domain.5 Finally, this simple and straightforward paper by Ozkavukcu et al.1 might lack some clinical perspective, but is really valuable as it highlights that complex and time-consuming laboratory modifications are not always necessary to improve outcome.