Surgical sperm retrieval in cases with non obstructive azoospermia, comparative study between maldescended and normal positioned testis

Background: Non-obstructive azoospermia (NOA) is absent sperm due to defective spermatogenesis from causes like cryptorchidism, genetics, or unknown factors. Aim: to compare surgical sperm retrieval rate in NOA between men with normally positioned scrotal testis/testes and undescended testis/testes. Patients and methods: This retrospective study included 869 men with NOA who underwent m-TESE between October 2016 and October 2023 at Beni-Suef University Hospital and IVF centers in Beni-Suef and Giza. After excluding 41 cases with confounding factors, 777 had scrotal testes and 92 had undescended testes (UDT) and were included in the analysis. Results: The study included 869 men with non-obstructive azoospermia (NOA) undergoing microdissection testicular sperm extraction (m-TESE), 777 (89.9%) had normally positioned scrotal testes, and 92 (10.1%) had undescended testes (UDT) [66 inguinal, 24 abdominal, 2 mixed]. Men with scrotal testes had higher testicular volume and E2 levels, but lower FSH and LH levels than UDT cases. Sperm retrieval rate (SRR) was significantly higher in scrotal testes (36.8%) compared to UDT (23.9%, p = 0.015), with no sperm retrieved from abdominal or mixed testes. Inguinal testes had an SRR of 33.3%. Earlier orchidopexy (12.4 ± 9.4 years) was associated with higher SRR (37.2% vs 12.2%, p = 0.007) compared to later orchidopexy (24.9 ± 13.8 years). Unilateral UDT showed higher SRR (40%) than bilateral (17.9%, p = 0.0517). Conclusion: Higher SRR was seen in scrotal and inguinal testes, especially when orchidopexy was done before 16.5 years. Abdominal testes showed no sperm, and genetics had no clear effect.