title: Optimal number of biopsies and impact of testicular histology on the outcome of testicular sperm extraction.
abstract: OBJECTIVE
  To determine the optimal number of biopsies in patients with non-obstructive azoospermia (NOA) who undergo testicular sperm extraction (TESE), and assess the impact of testicular histology on outcome.
  
  
  METHODS
  Seven hundred and forty-one patients with NOA who underwent TESE in our institution were enrolled in the study. Testicular sperm extraction was performed applying an open surgical technique on the larger testis. The number of biopsies varied according to the presence or absence of spermatozoa. No further biopsies were obtained once spermatozoa were detected. If no spermatozoa were seen, the procedure was continued to a maximum number of 5 biopsies, including a single biopsy of the contralateral testis.
  
  
  RESULTS
  Spermatozoa were obtained in 330 (44.5%) patients after a single biopsy. The success rate increased to 381 (51.4%), 416 (56.1%), 433 (58.4%), and 441 (59.5%) after the second, third, fourth, and contralateral sampling, respectively. Multiple sampling increased the success rate; however, success rate did not increase considerably after the third sampling. Performing contralateral testicular biopsy was advantageous in patients with uniform or mixed pattern hypospermatogenesis.
  
  
  CONCLUSIONS
  We recommend performing at least 3 biopsies in patients with NOA who undergo TESE. Further biopsies may also be advantageous when the NOA is a consequence of either uniform or mixed pattern hypospermatogenesis.
authors.affiliation: Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Dadkhah
authors.forename: Seyed Jalil
authors.initials: SJ
authors.lastname: Hosseini
authors.forename: Mohamad Ali
authors.initials: MA
authors.lastname: Sadighi Gilani
authors.forename: Faramarz
authors.initials: F
authors.lastname: Farrahi
authors.forename: Erfan
authors.initials: E
authors.lastname: Amini
authors.forename: Behrang
authors.initials: B
authors.lastname: Kazeminejad
mesh_terms: D053713:Azoospermia / Q000473:pathology*; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D053625:Sperm Retrieval / Q000706:statistics & numerical data*; D013737:Testis / Q000473:pathology*