Table 2.

Advantages and disadvantages of different retrieval/identification methods

Retrieval/identification method	Advantages	Disadvantages
Micro-TESE	Good chance of sperm recovery [4]	Risk of damage to testis architecture [7] Success may depend on surgical skill [7]
Multiphoton microscopy	3D in vivo histological images Depth of penetration up to 400 µm Real-time analysis [10] Lower energy laser = minimal damage [11] Decreased operating time	Human studies not conducted to determine risk of genetic damage [13]
Raman spectroscopy	Flexible probe for surgical ease Non-destructive near infrared light source [14]	Safety not assessed in human models Specimen preparation takes 2 minutes and can be influenced by light pollution [17]
Full-field optical coherence tomography	Fast and easy to obtain images [18] Safe light source from 150-W halogen lamp [19]	Absence of cellular details Limited depth of imaging below cellular surface [20] Only images ex vivo specimens [20] Efficacy not proven compared to other techniques [19]
ORBEye	Elimination of eyepieces allows for better surgical posture [21] Simple to use and easy to transport May allow for shorter surgery times [21] Wider FOV and longer DOF eliminates need for frequent repositioning [22] 3D viewing monitors provides optimal teaching/demonstration environment [23]	Cost Surgical assistants have rotated surgical view, which can lead to confusion during operation [24]
Ultrasonography	Fast, easy, portable [28] Widely available [28] Ability to locate areas of high perfusion [33] Help rule out areas of absent spermatogenesis [31] Improve success rates of sperm retrievals [36,37]	Operator dependent [38] Requires training and experience [38] Difficulty with resolving microvasculature of the testicle [31]
Artificial Intelligence	Automated assessment of extracted sperm [37,38,44] Real-time analysis of sperm [37] Ability to work with unstained images [37] High accuracy [37] Ability to predict outcomes prior to extraction [41] Avoid operator dependence [43]	Training phase of AI can be limited by the number of sperm images available [39] Limited by quality of microscopy images [39] Technology is not widely available Requires collaboration between computer scientists and clinicians

FOV: field of view; DOF, depth of field.