Is Redo Micro-TESE (Microdissection Testicular Sperm Extraction) as Effective as a Primary Micro-TESE in Men with Cryptozoospermia and Non-Obstructive Azoospermia (NOA)?

Background/Objectives: Microdissection testicular sperm extraction (micro-TESE) has optimized sperm retrieval rates in men with severe male factor infertility while minimizing testicular damage. We sought to evaluate sperm retrieval rates (SRR) in men with cryptozoospermia and non-obstructive azoospermia (NOA) undergoing primary and redo micro-TESE. Methods: We conducted a retrospective study of 216 consecutive primary micro-TESEs and 13 consecutive redo cases performed on the same testicular unit as the primary procedure in men with cryptozoospermia (n = 44) and NOA (n = 172). We compared outcomes of men with cryptozoospermia and NOA undergoing primary micro-TESE and evaluated outcomes of men who underwent redo micro-TESE after successful primary unilateral micro-TESE. Micro-TESE was deemed successful when at least five spermatozoa were identified after evaluation of the retrieved biopsies. Results: Men with cryptozoospermia undergoing a primary micro-TESE had a significantly higher sperm retrieval rate (SRR) than men with NOA (93% vs. 53% respectively, p < 0.001). Fewer men with cryptozoospermia than those with NOA required extensive dissection at micro-TESE (41% vs. 76%, p < 0.001). Thirteen men underwent a repeat micro-TESE after a successful primary unilateral micro-TESE, which achieved high SRR (92%), but 39% of these men required bilateral dissection. Conclusions: Our data demonstrate that the SRR of primary micro-TESE is significantly higher in men with cryptozoospermia compared to men with NOA. In a small, exploratory cohort, a redo micro-TESE after a successful initial procedure is associated with a high SRR but requires a more extensive dissection than the primary surgery.