title: A novel stepwise micro-TESE approach in non obstructive azoospermia.
abstract: BACKGROUND
  The purpose of the study was to investigate whether micro-TESE can improve sperm retrieval rate (SRR) compared to conventional single TESE biopsy on the same testicle or to contralateral multiple TESE, by employing a novel stepwise micro-TESE approach in a population of poor prognosis patients with non-obstructive azoospermia (NOA).
  
  
  METHODS
  Sixty-four poor prognosis NOA men undergoing surgical testicular sperm retrieval for ICSI, from March 2007 to April 2013, were included in this study. Patients inclusion criteria were a) previous unsuccessful TESE, b) unfavorable histology (SCOS, MA, sclerahyalinosis), c) Klinefelter syndrome. We employed a stepwise micro-TESE consisting three-steps: 1) single conventional TESE biopsy; 2) micro-TESE on the same testis; 3) contralateral multiple TESE.
  
  
  RESULTS
  SRR was 28.1 % (18/64). Sperm was obtained in both the initial single conventional TESE and in the following micro-TESE. The positive or negative sperm retrieval was further confirmed by a contralateral multiple TESE, when performed. No significant pre-operative predictors of sperm retrieval, including patients' age, previous negative TESE or serological markers (LH, FSH, inhibin B), were observed at univariate or multivariate analysis. Micro-TESE (step 2) did not improve sperm retrieval as compared to single TESE biopsy on the same testicle (step 1) or multiple contralateral TESE (step 3).
  
  
  CONCLUSIONS
  Stepwise micro-TESE could represent an optimal approach for sperm retrieval in NOA men. In our view, it should be offered to NOA patients in order to gradually increase surgical invasiveness, when necessary. Stepwise micro-TESE might also reduce the costs, time and efforts involved in surgery.
authors.affiliation: Department Gynaecological-Obstetrical and Urological Sciences, Sapienza University, via del Policlinico n 155 cap, 00161, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franco
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Scarselli
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Casciani
authors.affiliation: Department Urology, Sant' Andrea Hospital, Sapienza University, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Robotic Urology Department, Policlinico Abano Terme, Padova, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Dente
authors.affiliation: Department Gynaecological-Obstetrical and Urological Sciences, Sapienza University, via del Policlinico n 155 cap, 00161, Rome, Italy. costantino.leonardo@gmail.com.
authors.forename: Costantino
authors.initials: C
authors.lastname: Leonardo
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Greco
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Greco
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Minasi
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Rome, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Greco
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000473:pathology*; D013737:Testis / Q000473:pathology*
keywords: Azoospermia; ICSI; Micro-TESE; Sperm retrieval; TESE