The Use of Testicular Sperm Extraction in Male Infertility Patients Without Azoospermia

Testicular sperm extraction (TESE) in its various versions has been traditionally used in male infertility patients with azoospermia, with the intention of utilizing surgically retrieved sperm for in vitro fertilization (IVF) with or without intra-cytoplasmic sperm injection (ICSI). Possible risks of TESE include bleeding, infection, and inability to find sperm. Microdissection TESE, a more extensive type of surgical sperm retrieval procedure, may be associated with a transient post-operative decline in serum testosterone levels. More recently, the possibility of using TESE in non-azoospermic infertile men has been gaining attention. However, heterogeneity still exists in the available data. Older studies reported limited clinical benefits for the utilization of testicular over ejaculated spermatozoa, while newer publications suggest more promising outcomes for the utilization of surgically retrieved sperm for ICSI in non-azoospermic patients. Suggested indications for TESE in non-azoospermic infertile men included failure of IVF cycles utilizing ejaculated sperm, high sperm DNA fragmentation index, cryptozoospermia, and necrospermia. This editorial provides insight into the rationale, potential candidates and benefits for the consideration of TESE in non-azoospermic infertile men.