Second chance in fertility: a comprehensive narrative review of redo micro-TESE outcomes after initial failure

Haitham Elbardisi; Emre Bakircioglu; Wen Liu; Darren Katz

doi:10.4103/aja202446

Second chance in fertility: a comprehensive narrative review of redo micro-TESE outcomes after initial failure

Asian J Androl. 2024 Jul 19. doi: 10.4103/aja202446. Online ahead of print.

Authors

Haitham Elbardisi^{1

2

3}, Emre Bakircioglu⁴, Wen Liu^{5

6}, Darren Katz^{5

6

7}

Affiliations

¹ Hamad Medical Corporation, Doha 3050, Qatar.
² Department of Urology, Weill Cornell Medicine, Doha 24144, Qatar.
³ Qatar University College of Medicine, Doha 2713, Qatar.
⁴ SENSART Clinic, Istanbul 34365, Türkiye.
⁵ Men's Health Melbourne, Victoria, Melbourne, VIC 3000, Australia.
⁶ Department of Urology, Western Health, Victoria, St Albans, VIC 3021, Australia.
⁷ Department of Surgery, Western Precinct, University of Melbourne, VIC 3010, Australia.

PMID: 39028625
DOI: 10.4103/aja202446

Abstract

When microdissection testicular sperm extraction (micro-TESE) fails, a redo procedure may be the only option for patients who want a biological child. However, there are many gaps of knowledge surrounding the procedure, which need to be addressed to help clinicians and patients make informed decisions. This review explores redo micro-TESE in the context of nonobstructive azoospermia (NOA). Literature was searched using Google Scholar, Medline, and PubMed. Search terms were "NOA" AND "second microdissection testicular sperm extractions" AND "redo microdissection testicles sperm extraction" AND "repeat microdissection testicular sperm extractions" AND "failed microdissection testicular sperm extractions" AND "salvage microdissection testicular sperm extractions". Only original articles in English were included. A total of nine articles were included, consisting of four retrospective and five prospective studies. The time gap between the first and second micro-TESE varied from 6 months to 24 months. Most of the included studies reported successful surgical sperm retrieval (SSR) in the second micro-TESE in the range of 10%-21%, except in one study where it reached 42%. It has not been presented any definitive information about the use of hormonal treatment or the benefit of varicocelectomy prior to the second micro-TESE. Patients with hypospermatogenesis and Klinefelter syndrome (KS) had the highest chance of success in redo surgery. In conclusion, redo micro-TESE following a negative procedure can lead to sperm recovery in 10%-21%. Patients with hypospermatogenesis and KS have a higher chance of success. There is no enough evidence to conclude which is the best hormonal stimulation if any before a redo surgery.