title: How successful is TESE-ICSI in couples with non-obstructive azoospermia?
abstract: OBJECTIVE
  What are the chances of a couple with infertility due to non-obstructive azoospermia (NOA) having their genetically own child by testicular sperm extraction combined with ICSI (TESE-ICSI)?
  
  
  CONCLUSIONS
  Candidate TESE-ICSI patients with NOA should be counselled that, when followed-up longitudinally, only a minority (13.4%) of men embarking for TESE eventually become a biological father.
  
  
  BACKGROUND
  Data available in the literature are only fragmentary because they report either on sperm retrieval rates after TESE or on the outcome of ICSI once testicular spermatozoa has been obtained, mostly in a selected subpopulation. Unfortunately, reliable data to counsel men with NOA on their chance to become a biological father are still lacking.
  
  
  METHODS
  This is a retrospective cohort study performed in the Centre for Reproductive Medicine, University Hospital of Brussel, approved by the institutional review board of the hospital.
  
  
  METHODS
  We identified all patients with NOA, based on histology, who had their first testicular biopsy between 1994 and 2009. Patients were followed longitudinally during consecutive ICSI cycles with testicular sperm. The primary outcome measure was live birth delivery. The cumulative live birth delivery rate was calculated, based only on ICSI cycles with testicular sperm (fresh and/or frozen) available for injection. When patients delivered after transfer of supernumerary frozen embryos, this delivery was tallied up to the (unsuccessful) original fresh ICSI cycle. The sperm retrieval rate and pregnancy rate were secondary outcome measures.
  
  
  RESULTS
  Among the 714 men with NOA, 40.5% had successful sperm retrieval at their first TESE. In total, 261 couples had 444 ICSI cycles and 48 frozen embryo transfer cycles, leading to 129 pregnancies and 96 live birth deliveries. Crude and expected cumulative delivery rates after six ICSI cycles were 37 and 78%.
  
  
  CONCLUSIONS
  A retrospective cohort study design was the only way to study the cumulative delivery rate after TESE-ICSI in couples with NOA. Intrinsic limitations are related to the observational study design.
  
  
  CONCLUSIONS
  TESE-ICSI is a breakthrough in the treatment of infertility due to NOA, with almost 4 out of 10 (37%) couples having ICSI obtaining a delivery. However, unselected candidate NOA patients should be counselled, before undergoing TESE, that only one out of seven men (13.4%) eventually father their genetically own child.
  
  
  BACKGROUND
  None declared.
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium veerle.vloeberghs@uzbrussel.be.
authors.forename: V
authors.initials: V
authors.lastname: Vloeberghs
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Verheyen
authors.affiliation: Laboratory of Experimental Surgery and Centre for Outcomes Research, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Haentjens
authors.affiliation: Department of Pathology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Goossens
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: N P
authors.initials: NP
authors.lastname: Polyzos
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Tournaye
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000473:pathology / Q000628:therapy*; D001723:Birth Rate; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013737:Testis / Q000473:pathology; D016896:Treatment Outcome
keywords: ICSI; TESE; cumulative delivery rate; non-obstructive azoospermia; pregnancy