Testicular fine-needle aspiration in infertile men with absolute non-obstructive azoospermia: A single-centre cohort study

Background: The methodology of surgically extracted sperm cells in fertility treatments remains debated, mainly due to the lack of data evaluating its predictive value on treatment outcomes. Aim: To gain insight into the effectiveness of testicular fine-needle aspiration (TEFNA) in a cohort of infertile men with absolute non-obstructive azoospermia and to examine whether the number of retrieved sperm cells affects the fertilisation rate. Materials and Methods: A total of 89 infertile men, aged 26–47, meticulously diagnosed with non-obstructive azoospermia, participated in the study. All participants underwent TEFNA. The primary outcome measure was the TEFNA success rate in retrieving mature sperm. The secondary outcome measures included fertilisation rate, clinical pregnancy rates, and live births associated with the retrieved sperm. Results: Sperm cells were successfully retrieved from 40 out of 89 patients (45%) with no significant postoperative complications. Retrieval of up to ten sperm cells occurred in 11 procedures (25%); ten procedures (22.7%) resulted in producing dozens of sperm cells, and 100s to 1000s of sperm cells were obtained from the remainder of 23 procedures (52.3%). Patients whose TEFNA resulted in only a few sperm cells had a much lower fertilisation rate (16.6%) than the other two groups (40.1% and 47.2%, respectively, P = 0.003). Conclusions: The utilisation of TEFNA for sperm extraction in men with non-obstructive azoospermia is a simple, fast-learning, effective, and safe treatment option. In cases where sperm retrieval was successful, the fertilisation rate was strongly related to the number of sperm cells obtained.