Q: I am a 41 years old man. My semen analysis showed azoospermia, a volume of 2.5 ml, pH – 8, no agglutination. Blood tests reveal : LH - 12.8, FSH - 35.7, Serum Testosterone – 416, TSH - 1.66, Prolactin - 32.8 and PSA - 0.7. Chromosome testing is still pending. Assuming that the chromosome test comes normal, what are the chances of a successful pregnancy after undergoing intracytoplasmic sperm injection (ICSI)/ Testicular sperm extraction (TESE)? Do you recommend microdissection TESE over regular TESE in my case?

A:From the semen and hormonal parameters, it looks like you have non-obstructive azoospermia (problem with production of sperm). You will benefit from a testicular sperm extraction and we at Cornell have shown that microdissection technique has better outcomes (Ramasamy et al. 2005). The chances of sperm retrieval are about 60% and chances of pregnancy are around 40% (depends on female factors). Microdissection TESE is done in several centres across the US and some centres in Japan, Egypt and Belgium.