Non-obstructive Azoospermia is a concerning condition for any man. There are physical implications, of course, in that there’s no sperm in the semen, and the man cannot become a biological father. However, psychological considerations can also make azoospermia defeating. Many men find it very difficult to learn that the only option is relatively invasive microscopic surgery called MicroTESE which carries a 50% or less chance of finding sperm.
For most men, an alternative to the costly and invasive MicroTESE is a minimally invasive procedure known as testicular mapping (fine needle aspiration mapping). Unfortunately, there are very few reproductive urologists (male fertility specialists) around the United States, including Dr. Kapadia, who perform testicular mapping for azoospermia. As such, Dr. Kapadia sees patients from all over the US who are interested in this procedure.
A note on azoospermia. It’s essential to understand that while there may be no sperm in the semen, it does not mean that the testes do not produce any sperm at all. On average, about 50% of men with nonobstructive azoospermia may have sperm being produced in the testicles.¹ As such, Dr. Kapadia sees less invasive options as essential to caring for the 1% of all men with non-obstructive azoospermia. There is significant data in support of testicular mapping published in urologic literature, as outlined by publications from Dr. Kapadia and colleagues.²
What Are the Two Procedures?
Testicular mapping or FNA mapping is a minimally invasive procedure that uses Fine Needle Aspiration (FNA) to check for sperm in various parts of the testes. By creating a map of where sperm is being produced, Dr. Kapadia creates a guide for follow-up procedures like a simple sperm retrieval procedure such as TESA/TESE or even a microTESE to minimize invasiveness and improve success rates. It is worth noting that testicular mapping is purely a diagnostic procedure and does not extract usable sperm.
Microscopic testicular sperm extraction (microTESE)
A microTESE, on the other hand, is often used as both a diagnostic and extractive procedure. Like testicular mapping, a microTESE finds sperm in about 45-50% of men with azoospermia. However, this procedure carries a much higher cost and is more invasive. Ultimately, for half of the men in whom sperm is not found, this intervention carries a significant cost burden, complication risk, and recovery time compared to testicular mapping.
Is One Procedure Better?
The value of each procedure is in the way it is utilized. Both procedures can work hand-in-hand to offer patients a less invasive but accurate idea of whether they can become biological fathers. When testicular mapping is used as a precursor to a targeted microTESE, patients often undergo the microTESE on only one testicle with a significantly higher chance of finding sperm while also minimizing the risk of complications and time to recovery.
Visiting a Male Fertility specialist like Dr. Kapadia, who specializes in testicular mapping, is an excellent way to understand your next steps and treatment options for azoospermia.
- Sharma M, Leslie SW. Azoospermia. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578191/
- Kapadia AA, Walsh TJ. Testicular Mapping: A Roadmap to Sperm Retrieval in Nonobstructive Azoospermia? Urol Clin North Am. 2020 May;47(2):157-164. doi: 10.1016/j.ucl.2019.12.013. PMID: 32272987.