Testicular Mapping Biopsy in Non-obstructive Azoospermia (NOA) Patients: A Case Series from Indonesia

Abstract

Introduction: Non-obstructive azoospermia (NOA) is often considered the most severe spectrum of male infertility. Focal spermatogenesis that occurs in NOA patients has made successful sperm retrieval very challenging. Testicular mapping biopsy is a minimally invasive sperm retrieval technique that provides significant information concerning focal spermatogenesis in NOA patients. This case series describes the early clinical experience and results of testicular mapping biopsy in Indonesian patients with NOA. It includes patients who have a history of unsuccessful testicular sperm extraction (TESE) procedures. Case Presentation: In this case series, we report the first 6 testicular mapping biopsy cases performed in Indonesia. These patients were previously screened for every possible male infertility etiology. Our patients presented with different underlying pathologies for male infertility, such as hormonal impairment, varicocele, and gr/gr deletion. Thereafter, patients were thoroughly counseled for testicular mapping biopsy. Our first experience with testicular mapping biopsy shows promising results with a 57.2% sperm retrieval rate. There were 2 out of 4 (50%) patients who had successful sperm retrieval by testicular mapping biopsy after previously failed TESE. There were no adverse effects of this procedure in all cases. Discussion: Testicular mapping biopsy is a novel sperm retrieval technique to treat NOA patients. The sperm retrieval rate of this procedure is comparable to TESE/microsurgical testicular sperm extraction (microTESE), with the advantage of minimal invasiveness and providing valuable information concerning focal spermatogenesis. Testicular mapping biopsy can also help treat NOA patients with previously failed TESE/microTESE. This procedure is well tolerated, with mild side effects such as spermatic cord hematoma, painless gross hematospermia, and pain. All complications were resolved within a week. Conclusions: Testicular mapping biopsy is a novel technique for treating NOA. It has a relatively high sperm retrieval rate comparable to TESE and microTESE. Furthermore, testicular mapping biopsy opens the possibility of sperm retrieval for patients with previously failed TESE or microTESE. The procedure is also well-tolerated by patients and does not have the adverse effect of reduced testosterone and potential hypogonadism as is the case with TESE or microTESE.