Testicular sperm extraction (TESE) and testicular sperm detection by fine needle aspiration (TEFNA) are both acceptable methods for sperm retrieval for non-obstructive azoospermia (NOA) men. The aim of the study was to determine the predictability of TEFNA to sperm detection by either TEFNA or TESE of the second testicle and to compare fertilization rate (FR) of testicular spermatozoa retrieved by each method. Sixty one men diagnosed with non-obstructive azoospermia (NOA) participated in this prospective study. All patients had a sperm recovery trial by TEFNA on a single randomly selected testicle (10-20 punctures with 23-gauge butterfly needle) and either TEFNA or TESE on the contralateral testicle at the same surgical session. The procedure was considered successful if at least 1 spermatozoon per 5μL was retrieved for use in the coming cycle of IVF-ICSI. We found that TEFNA could successfully predict all successful TESE cases (100% PPV and 88% NPV), whereas unsuccessful TEFNA was followed by successful TESE in 12.5% of cases. The mean number of spermatozoa collected by TEFNA vs. TESE was 1749±3175 (range 0-10,000) vs. 14129 +18005 (range 24-40800), respectively (p=0.033). TEFNA could successfully predict all successful TEFNA of the second testis (100% PPV and 95% NPV). The FR of MII oocytes was similar for sperm retrieved by either TEFNA or TESE. We conclude that in NOA patients successful TEFNA is fully predictive of both successful TESE and TEFNA on the contralateral testis. However, unsuccessful TEFNA may not predict the outcome of TESE in 12.5% of cases, most probably due to the numerical superiority of TESE. Spermatozoa collected by both methods share similar fertilization potential.
