Repeat and Redo Microdissection Testicular Sperm Extraction (Micro-TESE) in Non-Obstructive Azoospermia: A Narrative Review

Microdissection testicular sperm extraction (micro-TESE) is the standard surgical approach for sperm retrieval in men with non-obstructive azoospermia (NOA). However, further procedures may be required either after successful retrieval to support additional intracytoplasmic sperm injection cycles or as salvage treatment following initial failure. This narrative review evaluates outcomes of repeat micro-TESE after previous success and redo micro-TESE after failure, focusing on sperm retrieval rates (SRRs), predictors of success, and strategies proposed to optimize outcomes before reoperation. Repeat procedures following successful retrieval generally show high SRRs, with one large series reporting rates of 73.9–92.5% at subsequent attempts; however, these estimates reflect progressively selected populations and should not be interpreted as independent per-attempt probabilities. In contrast, redo micro-TESE after initial failure achieves sperm retrieval in approximately 10–21% of cases in most series, although higher rates have occasionally been reported. Previous retrieval outcome and testicular histopathology appear most informative for counselling, whereas serum FSH, testicular volume, genetics, and the interval between procedures have inconsistent predictive value. Hormonal pretreatment may modify the intratesticular environment, but evidence for improved redo retrieval remains limited and heterogeneous. Antioxidant therapy is biologically plausible but has not been adequately evaluated in this setting. Technical factors, including the adequacy of the initial procedure, surgical expertise, and laboratory processing, may also influence outcomes. Prospective controlled studies with standardized reporting are needed to define optimal patient selection and management before repeat or redo micro-TESE.