Which approach is often used to maximize sperm yield in non-obstructive azoospermia?

• A. PESA (epididymal)
• B. MESA (epididymal)
• C. micro-TESE (microdissection testicular)
• D. TESE (testicular biopsy)

Answer: (C)

Non-obstructive azoospermia often involves scattered areas of active spermatogenesis rather than uniform production. Micro-TESE uses an operating microscope to examine individual seminiferous tubules and selectively biopsy those that look most likely to contain sperm. This targeted, magnified search increases the chance of finding usable sperm while removing less tissue, which explains why it yields more sperm in NOA and minimizes damage to the testicle. Epididymal approaches (PESA or MESA) retrieve sperm from the epididymis and are more relevant for obstructive causes; in NOA the problem is production, so epididymal retrieval is less reliable. Conventional TESE without magnification is less selective and often requires removing more tissue with potentially lower yield.