High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction

Objective: To evaluate the outcomes of microdissection testicular sperm extraction (micro-TESE) in patients with high FSH. Design: Clinical retrospective study. Setting: Department of urology at a tertiary university hospital. Patient(s): Seven hundred ninety-two men with nonobstructive azoospermia. Intervention(s): Micro-TESE followed by intracytoplasmic sperm injection was performed. The men were classified into four groups based on serum FSH levels: <15, 1.5-30, 31-45, and >45 IU/mL. Main Outcome Measure(s): Sperm retrieval, clinical pregnancy, and live birth rates. Result(s): Testicular sperm were successfully retrieved in 60% of the men. Sperm retrieval rates in the groups of men with FSH values 15-30, 31-45, and >45 IU/mL was 60%, 67%, and 60% respectively; this was higher than the group of men with FSH < 15 (51%). Of those men who had sperm retrieved, clinical pregnancy and live birth rates were similar in the four groups (46%, 50%, 52%, 46% and 38%, 45%, 44%, 36%, respectively). Conclusion(s): The chances of sperm retrieval using micro-TESE is just as common, if not better for men with elevated FSH levels than for men with lower FSH. Micro-TESE results appear to differ from earlier series that report low retrieval rates with random biopsies for men with elevated FSH. High FSH is not a contraindication for micro-TESE. (Fertil Steril (R) 2009;92:590-3. (C)2009 by American Society for Reproductive Medicine.)