SUCCESSFUL MICRODISSECTION TESTICULAR SPERM EXTRACTION DESPITE HIGH SERUM FOLLICLE STIMULATING HORMONE LEVELS IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA

Objective: Non-obstructive azoospermia, defined as absence of spermatozoa in the ejaculate caused by impaired spermatogenesis, is the most severe cause of male infertility. It is typically presented as high serum follicle stimulating hormone levels and atrophic testis. The combination of intracytoplasmic sperm injection and Microdissection testicular sperm extraction allows these infertile men the opportunity to have their own children from their own testis. Our aim was to evaluate the outcomes of micro-Testicular sperm extraction in men with atrophic testis.Study Design: The medical records of 80 non-obstructive men with azoospermia who underwent micro-TESE were retrospectively evaluated. We assessed clinical parameters; age, duration of infertility, smoking, chromosomal karyotype, Y chromosome microdeletion, follicle stimulating hormone, luteinizing hormone, total testosterone and testicular volume in relation with Microdissection testicular sperm extraction results.Results: Testicular sperm retrieval rate was 53% in 80 patients. Testicular volume, serum follicle stimulating hormone and total testosterone concentrations showed correlation with the results of sperm retrieval. These three parameters were found to be significant risk factors with testicular sperm extraction negative patients (p<0.001). The odds ratios (95% CI) were 6.39 (1.25–26.58), 1.24 (1.11-1.36), 1.13 (0.99-1.21) respectively. Testicular volume was found to be a discriminative parameter in patients with negative sperm retrieval. The cut-off point was established as 6.75 ml for testicular volume with 88.1% sensitivity, 62.1% specificity.Conclusion: Microdissection testicular sperm extraction is the most effective procedure for patients with non-obstructive azoospermia. Testicular volume, serum follicle stimulating hormone and testosterone levels can be predictive factors for sperm retrieval in men with non-obstructive azoospermia.

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Evaluation of neoadjuvant gonadotropin administration with downregulation by testosterone prior to second time microsurgical testicular sperm extraction: A prospective case–control study

Urologia Journal ◽

10.1177/0391560320913401 ◽

2020 ◽

Vol 87 (4) ◽

pp. 185-190

Author(s):

Medhat Kamel Amer ◽

Hossam ElDin Hosni Ahmed ◽

Sameh Fayek GamalEl Din ◽

Ahmed Fawzy Megawer ◽

Ahmed Ragab Ahmed

Keyword(s):

Follicle Stimulating Hormone ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Hormone Levels ◽

Significant Difference ◽

Group A ◽

Group B ◽

Stimulating Hormone

Purpose: The aim of this prospective study was to determine whether there is a beneficial role of combining gonadotropin administration with testosterone downregulation in non-obstructive azoospermia patients prior to a second time microsurgical testicular sperm extraction after a negative one. Methods: A total of 40 non-obstructive azoospermia men were recruited from a specialized IVF center from 2014 to 2016. Participants were divided equally into two groups: Group A was subjected to testosterone downregulation alone for 1 month and then combined with gonadotropin administration for 3 months prior to second time testicular sperm extraction; Group B (controls) underwent second time microsurgical testicular sperm extraction without prior hormonal therapy. Results: Mean baseline follicle-stimulating hormone levels of the controls and the cases were 26.9 ± 11.8 and 25.4 ± 8.7, respectively. One month after testosterone downregulation, follicle-stimulating hormone level of the cases was normalized and became 2.4 ± 1.2. There was no statistically significant difference between baseline follicle-stimulating hormone levels of the controls and cases (p = 0.946). Remarkably, two cases were positive after downregulation (10%) and no controls were positive at second testicular sperm extraction (0%). There was no statistically significant difference between sperm retrieval after the second microsurgical testicular sperm extraction in the controls and the cases (p = 0.072). Conclusion: Patients who underwent first time testicular sperm extraction with unfavorable outcome due to different techniques may benefit from testosterone downregulation combined with neoadjuvant gonadotropin administration as it had shown positive sperms retrieval in 2 out of the 20 cases, especially those with hypergonadotropic azoospermia.

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Faculty Opinions recommendation of Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739218520.793581238 ◽

2020 ◽

Author(s):

Suks Minhas ◽

Tharu Tharakan

Keyword(s):

Follicle Stimulating Hormone ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Stimulating Hormone

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Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men

Human Reproduction ◽

10.1093/humrep/13.5.1230 ◽

1998 ◽

Vol 13 (5) ◽

pp. 1230-1234 ◽

Cited By ~ 97

Author(s):

D. Jezek ◽

U. A. Knuth ◽

W. Schulze

Keyword(s):

Semen Analysis ◽

Follicle Stimulating Hormone ◽

High Serum ◽

Testicular Sperm Extraction ◽

Testicular Sperm ◽

Infertile Men ◽

Serum Hormone ◽

Testicular Morphology ◽

Stimulating Hormone

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Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia

Archives of Endocrinology and Metabolism ◽

10.20945/2359-3997000000217 ◽

2020 ◽

Author(s):

Bahia Namavar Jahromi ◽

Shahryar Zeyghami ◽

Mohammad Ebrahim Parsanezhad ◽

Parvin Ghaemmaghami ◽

Afsoon Zarei ◽

...

Keyword(s):

Follicle Stimulating Hormone ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Stimulating Hormone

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Endocrine predictors of testicular biopsy efficacy in patients with azoospermia

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-3-38-42 ◽

2017 ◽

Vol 176 (3) ◽

pp. 38-42

Author(s):

V. A. Toropov ◽

S. Yu. Borovets ◽

S. Kh. Al’-Shukri ◽

A. M. Gzgzyan ◽

V. Ya. Belousov ◽

...

Keyword(s):

Blood Plasma ◽

Follicle Stimulating Hormone ◽

Testicular Biopsy ◽

Sex Steroid ◽

Testicular Sperm Extraction ◽

Testicular Sperm ◽

Low Probability ◽

Steroid Binding ◽

In Blood Plasma ◽

Stimulating Hormone

OBJECTIVE. The study identified predictors of endocrine detection of sperm in case of open testicular biopsy in patients with non-obstructive azoospermia. MATERIAL AND METHODS. The research was based on the results of examination and testicular biopsy of 76 patients with secretory azoospermia aged from 20 to 55 years old. The instrumental, laboratory, physical methods of research were carried out for all the patients before performing of the open biopsy for testicular sperm extraction. Hormone levels were determined in blood plasma such as luteinizing hormone, follicle stimulating hormone, prolactin, total and free testosterone, estradiol and sex steroid binding globulin. Patients were divided into two groups. The first group consisted of patients (n =43) whom sperms were found in testicular biopsies. The second group included patients (n = 33) whom sperms weren’t detected. RESULTS. Сonсentration of follicle stimulating hormone in blood plasma was the most significant hormone predictor. It was found that follicle stimulating hormone level between 12 and 16 IU/L indicated to the low probability of sperm presence in testicular biopsies and in case it was less than 17 IU/L the probability was extremely low. There was also established that elevated follicle stimulating hormone levels in patients older than 26 years pointed to the low probability of finding sperm using open testicular sperm extraction. CONCLUSIONS. Increase of luteinizing hormone, follicle stimulating hormone or their correlation in blood plasma indicates to a low probability of finding sperm by open testicular sperm extraction. The concentrations of testosterone, sex steroid binding globulin, prolactin and estradiol in the blood plasma weren’t reliable predictors of finding sperm in testicular biopsies.

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Predictive value of serum follicle stimulating hormone for testicular sperm extraction by multiple needle aspiration testicular biopsies

Medpusle International Journal of Surgery ◽

10.26611/1061723 ◽

2020 ◽

Vol 17 (2) ◽

pp. 32-35

Author(s):

Sandeep Bathe ◽

Keyword(s):

Predictive Value ◽

Follicle Stimulating Hormone ◽

Needle Aspiration ◽

Testicular Sperm Extraction ◽

Testicular Sperm ◽

Stimulating Hormone

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Impact of age, follicle stimulating hormone and Johnsen’s score on successful sperm retrieval by microdissection testicular sperm extraction

Reproductive Medicine and Biology ◽

10.1007/bf03016137 ◽

2005 ◽

Vol 4 (1) ◽

pp. 53-57

Author(s):

Akira Tsujimura ◽

Yasushi Miyagawa ◽

Tetsuya Takao ◽

Kazutoshi Fujita ◽

Kazuhiko Komori ◽

...

Keyword(s):

Follicle Stimulating Hormone ◽

Testicular Sperm Extraction ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Stimulating Hormone

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Relevance of testicular histopathology on prediction of sperm retrieval rates in case of non-obstructive and obstructive azoospermia

Urologia Journal ◽

10.1177/0391560318758940 ◽

2018 ◽

Vol 85 (2) ◽

pp. 60-67 ◽

Cited By ~ 3

Author(s):

Gianmartin Cito ◽

Maria E Coccia ◽

Sara Dabizzi ◽

Simone Morselli ◽

Pier A Della Camera ◽

...

Keyword(s):

Follicle Stimulating Hormone ◽

Needle Aspiration ◽

Testicular Sperm Extraction ◽

Total Testosterone ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Maturation Arrest ◽

Fine Needle ◽

Normal Spermatogenesis

Introduction: The aim of our research was to establish the relevance of testicular histopathology on sperm retrieval after testicular sperm extraction in patients with non-obstructive azoospermia and in patients with obstructive azoospermia, who already underwent a previous failure testicular fine needle aspiration. Methods: We evaluated a total of 82 azoospermic men, underwent testicular sperm extraction, referring to the Assisted Reproductive Technology Centre of the University of Florence, Italy between January 2008 and March 2017. A general and genital physical examination, scrotal and trans-rectal ultrasound, semen analysis, hormone measurements, including follicle-stimulating hormone, luteinizing hormone and total testosterone, were collected. Results: Successful sperm retrieval was obtained in 36 men of total (43.9%). Successful sperm retrieval was 29.5% in non-obstructive azoospermia patients, while men with obstructive azoospermia, who, underwent a previous failure testicular fine needle aspiration, had sperm retrieval in 86% of cases. Mean luteinizing hormone was 6.55 IU/L, total testosterone 4.70 ng/mL, right testicular volume 13.7 mL and left testicular volume 13.6 mL. Mean Follicle-stimulating hormone was 13.45 IU/L in patients with negative sperm retrieval and 8.18 IU/L in men with successful sperm retrieval. According to histology, 20.7% had normal spermatogenesis, 35.3% hypospermatogenesis, 35.3% maturation arrest and 8.5% Sertoli cell-only syndrome. Successful sperm retrieval was 88.2% in patients with normal spermatogenesis, 24.1% in the maturation arrest group and 48.27% in patients with hypospermatogenesis, while negative sperm retrieval was reported in Sertoli cell-only syndrome patients. Seven cases with maturation arrest showed a successful sperm retrieval. Conclusion: Testicular histopathology after testicular sperm extraction offers important information on prediction of sperm retrieval and can guide the surgeon in choosing the more suitable therapeutic practice.

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