To determine reproductive urologists’ (RU) practice patterns for microdissection testicular sperm extraction (microTESE) and factors associated with use of fresh versus frozen microTESE for non-obstructive azoospermia (NOA).
We electronically surveyed Society for Study of Male Reproduction members with a 21-item questionnaire. Our primary outcomes were to determine RU preference for fresh or frozen microTESE and to understand barriers to performing microTESE. Pearson’s chi-square and Fisher’s exact tests were used to analyze categorical outcomes and candidate predictor variables. Firth logistic regression was performed to identify the predictors for preferring and performing fresh versus frozen microTESE.
A total of 208 surveys were sent with 76 responses. Most (63.0%) primarily perform frozen microTESE for NOA, while 37.7% primarily perform fresh. However, in an ideal practice, 59.3% prefer fresh microTESE and 22.2% prefer frozen microTESE. MicroTESE is performed most often (61.1%) at surgical centers not affiliated with a fertility practice. The most commonly reported barriers for both fresh and frozen microTESE are cost (42.6%), scheduling (33.3%), and andrologist unavailability (16.7%). There are no statistically significant differences between these barriers and performing fresh versus frozen microTESE. On multivariable analysis, REI-based surgical center (OR 22.9; 95% CI 1.1-467.2; p=0.04) and professional fee $2,500-$4,999 (OR 20.7; 95% CI 1.27-337.9; p=0.03) are significant predictors of performing fresh microTESE.
Frozen microTESE is performed more commonly than fresh, despite most RU preferring fresh microTESE in an ideal setting. Both fresh and frozen microTESE have a role in reproductive care. Barriers to performing fresh microTESE include cost, scheduling and andrologist availability.

Copyright © 2021. Published by Elsevier Inc.