Extensive research has been conducted in search of factors that can predict the likelihood of successful testicular sperm retrieval in nonobstructive azoospermia patients. Clinical factors such as patient age, testicular volume, presence of varicocele, cryptorchidism, and Klinefelter syndrome; laboratory factors such as serum FSH level, inhibin B level, and presence of genetic disturbances; and the histopathologic pattern of testicular tissue have all been investigated in the literature. Of all the above-mentioned factors, the histopathologic pattern appears to be most influential in predicting surgical sperm retrieval outcome.

The development of surgical sperm retrieval procedures can be considered as the single most important breakthrough in the field of male infertility. Various testicular sperm retrieval procedures exist and are indicated in patients with obstructive and nonobstructive azoospermia, as well as patients with high levels of sperm DNA fragmentation and severe derangements in semen parameters. Microsurgical testicular sperm extraction can be considered the gold standard retrieval method as it allows meticulous and selective sampling of sperm-containing seminiferous tubules, yielding the highest retrieval rate in comparison to other surgical sperm retrieval methods.

There are a variety of management options for male infertility patients. Often, assisted reproductive technology allows for successful pregnancies and live births using an ejaculated semen sample. If the etiology of the infertility precludes a satisfactory ejaculated semen sample, sperm retrieval may be required. Determining if a patient is a candidate for sperm retrieval involves a thorough history and physical exam, semen analysis, endocrine evaluation and, likely, genetic assessment. Men who are candidates for sperm retrieval may be azoospermic or anejaculatory. Understanding the etiology of azoospermia is critical to determining the most effective sperm retrieval approach.