The Infertile Male-5: Management of Non-Obstructive Azoospermia

  • Mirco Castiglioni
  • Elisabetta M. Colpi
  • Fabrizio I. Scroppo
  • Giovanni M. Colpi
Part of the Medical Radiology book series (MEDRAD)


Surgical testicular sperm retrieval for intra-cytoplasmic sperm injection purposes is the only possibility of biological fathering in case of non-obstructive azoospermia (NOA). Successful retrieval only correlates with histology, not with FSH values or testicular volume. Testicular sperm extraction (TESE) (mean of successful retrievals in the literature: 52.7%) is the technique of choice: we had successful retrievals in 100% of cases of hypospermatogenesis with >5 spermatids/tubule (spd/tub), 81.8% of cases of hypospermatogenesis with <4 spd/tub, 50% of cases of maturation arrest, and 25% of cases of histologically pure Sertoli cell only syndrome. Microsurgical TESE (MicroTESE) has been reported to increase successful retrievals: from 16.7 to 45% for standard TESE to 42.9–63.6% for MicroTESE, depending on the distribution of testicular histology in the various case studies. TeFNA does not appear to be indicated in NOA, both because of its low success rates—which, in practice, are only positive in hypospermatogenesis, and because it is unable to detect any carcinomas in situ. Previous surgery of left varicocele in NOA could increase the chances of subsequent recovery.


Intracytoplasmic Sperm Injection Testicular Volume Tunica Albuginea Sperm Retrieval Obstructive Azoospermia 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Mirco Castiglioni
    • 1
  • Elisabetta M. Colpi
    • 2
  • Fabrizio I. Scroppo
    • 3
  • Giovanni M. Colpi
    • 1
  1. 1.Andro-Urology and IVF UnitUniversity of MilanMilanItaly
  2. 2.Biogenesi IVF CenterIstituti Clinici ZucchiMonzaItaly
  3. 3.Urology UnitOspedale di Circolo e Fondazione MacchiVareseItaly

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