While men with non-obstructive azoospermia (NOA) can often conceive a biological child, the sperm retrieval process is frequently complex and uncertain. Microscopic testicular sperm extraction (microTESE) is widely regarded as the best method for sperm retrieval, and one which offers the highest chance of finding viable sperm. However, the procedure is costly, invasive, and has a 40-50% failure rate, making finding other, more efficient and predictable options essential.
Fine Needle Aspiration Mapping (FNAM) has emerged as one such potential tool to enhance the sperm retrieval process for men with NOA. FNAM can be performed before microTESE to help predict the likelihood of success and reduce the chances of failure to retrieve sperm. While promising, there’s limited comparative research between the two and little evidence on efficacy and outcomes.
A study published in Translational Andrology and Urology performed a direct comparison of sperm retrieval, pregnancy, and live birth rates following FNAM-guided retrieval and upfront microTESE, with the aim of optimizing sperm retrieval strategies for men with NOA.
FNAM first?
The study, titled “Testicular mapping-guided sperm retrieval vs. upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live births”, included 90 men with NOA over a 10-year period. 60 of these underwent FNAM, and 30 upfront microTESE. Among the FNAM group, 56.7% had a positive FNA map for spermatogenesis. Of those, sperm retrieval was successful in 96.8% who proceeded with either FNAM-guided testicular sperm aspiration/extraction (TESA/E) or MicroTESE. The overall sperm retrieval rates were similar between the FNAM and upfront microTESE groups, with no statistically significant difference. Pregnancy and live birth rates were also comparable, suggesting that FNAM is a reliable predictor of SR success without compromising fertility outcomes.
These findings raise questions about retaining upfront microTESE as the default approach for sperm retrieval in NOA patients. While the procedure can be highly effective, the study suggests that FNAM can also play an important role in guiding treatment decisions. FNAM’s advantage lies in its predictive capability, unlike microTESE. The ability to map sperm production in the testicles allows for a more targeted approach to retrieval, potentially saving some patients from undergoing microTESE when FNAM-guided TESA/E could be effective. Considering the financial and physical toll associated with microTESE, alongside the emotional struggles of infertility, this is particularly relevant.
Key Takeaway
While this study provides evidence in favor of incorporating FNAM into the sperm retrieval process, further research is needed to refine its practical benefits and whether or not it should be routinely recommended before microTESE. Undoubtedly, the findings of this study continue to reinforce the importance of personalized treatment plans and their potential to lead to better patient experiences and reproductive outcomes.
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