title: Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest.
abstract: OBJECTIVE
  To evaluate sperm retrieval in men with nonobstructive azoospermia and maturation arrest (MA) undergoing microdissection testicular sperm extraction (micro-TESE).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Men with nonobstructive azoospermia and MA who underwent micro-TESE.
  
  
  METHODS
  Microdissection TESE.
  
  
  METHODS
  Sperm retrieval rate (SRR).
  
  
  RESULTS
  A total of 211 patients (13%) had a histologic finding of MA at the most advanced level. The overall SRR was 52%. A total of 146 patients were classified as having early MA (arrest at the primary spermatocyte stage), and 65 as having late MA (early spermatid stage). The SRR in men with early, vs. late, MA was 40% vs. 78%. Of the 211 men with MA, 51 had diffuse MA (100% of tubules showed MA). The SRR was significantly lower in men with diffuse vs. focal MA (35% vs. 57%). On multivariable analysis, late MA and higher follicle-stimulating hormone levels were positively associated with successful sperm retrieval.
  
  
  CONCLUSIONS
  Sperm were successfully identified in up to one half of the men with MA after micro-TESE. Among men with MA, late MA seems to be the best predictor of successful sperm retrieval with micro-TESE.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Bernie
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Kalee
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Halpern
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Jason
authors.initials: J
authors.lastname: Scovell
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.affiliation: Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Robinson
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York. Electronic address: pnschleg@med.cornell.edu.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005298:Fertility; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D042282:Microdissection; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D013079:Sperm Maturation; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000473:pathology*; D016896:Treatment Outcome
keywords: Microdissection testicular sperm extraction; maturation arrest; nonobstructive azoospermia