(092) TESTICULAR CORE EXTRACTION REDUCES NEED FOR MICROSCOPIC TESTICULAR SPERM EXTRACTION BY 75% IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA

Abstract Introduction Current AUA guidelines recommend proceeding to microTESE (mTESE) for patients with non-obstructive azoospermia (NOA). Herein, we propose that that conventional Testicular Sperm Extraction (cTESE) is an effective and preferred first-line technique for sperm retrieval in men with NOA who first undergo a diagnostic testicular core extraction (TCE). Objective To comprehensively characterize TCE and cTESE as important diagnostic and therapeutic tools, respectively, we present a large cohort study to confirm our proposed algorithm. Methods We identified 187 patients presenting with NOA in our clinic from January 1, 2019 – March 25, 2024. All patients underwent diagnostic TCE that if positive for sperm was followed by cTESE. Chart review was performed, and summary statistics were calculated for tested variables, using chi squared analysis for categorical variables and Kruskal Wallis analysis for non-parametric continuous variables. P < 0.05 deemed significance. Results Under current guidelines, all 66 patients who underwent cTESE for NOA would have undergone mTESE. Of these patients, 97.8% had sperm on cTESE sufficient for IVF/ICSI. Those patients who did not have sperm on TCE were offered mTESE. 16 elected to proceed, of which 4 (25%) were found to have sufficient sperm at the time of egg retrieval. In patients with NOA, the only significant predictor of cTESE success was TCE. Other covariates that significantly differed between patients with sperm and those without on TCE included lower FSH (p = 0.001) and LH (p = 0.005). However, these variables were not significant in predicting TCE efficacy for NOA patients. Conclusions TCE was the only tested variable statistically associated with cTESE outcome. By pretesting NOA patients with TCE as a method of selection we achieved a 97.8% sensitivity of predicting a positive cTESE outcome in NOA patients and spared 75% of those patients from mTESE. This algorithm for NOA patient management costs significantly less while maintaining efficacy. Disclosure No.