scholarly journals Semen biomarker TEX101 predicts sperm retrieval success for men with testicular failure

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 569
Author(s):  
Keith Jarvi ◽  
Peter Schlegel ◽  
Christina Schiza ◽  
Andrei Drabovich ◽  
Susan Lau ◽  
...  
Keyword(s):  
Leydig Cells ◽  
Specific Protein ◽  
Obstructive Azoospermia ◽  
Success Rates ◽  
Sperm Retrieval ◽  
Retrieval Failure ◽  
Exact Test ◽  
Non Invasive ◽  
Normal Men ◽  
Semen Biomarker

Background:  Azoospermia could be due to either obstruction (obstructive azoospermia: OA) or spermatogenic failure (non-obstructive azoospermia: NOA). Close to 50% of men with NOA have small pockets of sperm in the testis which could be retrieved surgically and then injected into oocytes in a program of intra-cytoplasmic sperm insertion. Presently, there are no accepted non-invasive tests allowing clinicians to predict the success rates of sperm retrieval. Previously, we have identified a germ cell-specific protein TEX101 in semen found in the primary spermatocytes and more mature sperm forms, but not in spermatogonia, Sertoli or Leydig cells. We hypothesized that the semen concentration of TEX101 could be used to predict sperm production in men with NOA.  Methods:   This was a prospective cohort study on men with NOA being treated at a male infertility centre.   Men with NOA planning sperm retrieval provided 1–3 semen samples prior to surgery.  Semen TEX101 concentrations were measured by an in-house-developed ELISA assay and compared with the results of the surgery to retrieve sperm.   Results:  20/60 karyotypically normal men with NOA had semen TEX101 < LOD (<0.2ng/mL).  Of these, 0% had successful sperm retrieval(0-17%: 95% CI) .  In contrast, of the 40 men with TEX101> LOD, sperm was found in 50% (34-66%: 95% CI, sig diff. Fisher’s exact test, p<0.05). Conclusions:  Undetectable (<0.2 ng/mL) semen TEX101 is highly predictive of sperm retrieval failure for karyotypically normal men with NOA and is the single strongest non-invasive predictor of sperm retrieval failure reported so far. Semen TEX101 concentration will help couples decide their individual chances of successful sperm retrieval.

Causes of azoospermia and their management

2004 ◽  
Vol 16 (5) ◽  
pp. 561 ◽  
Author(s):  
P. N. Schlegel
Keyword(s):  
Reproductive Tract ◽  
Microscopic Analysis ◽  
In Vitro Fertilisation ◽  
Obstructive Azoospermia ◽  
Success Rates ◽  
Sperm Production ◽  
Sperm Retrieval ◽  
Prognostic Information ◽  
Male Reproductive Tract

Azoospermia may occur because of reproductive tract obstruction (obstructive azoospermia) or inadequate production of spermatozoa, such that spermatozoa do not appear in the ejaculate (non-obstructive azoospermia). Azoospermia is diagnosed based on the absence of spermatozoa after centrifugation of complete semen specimens using microscopic analysis. History and physical examination and hormonal analysis (FSH, testosterone) are undertaken to define the cause of azoospermia. Together, these factors provide a >90% prediction of the type of azoospermia (obstructive v. non-obstructive). Full definition of the type of azoospermia is provided based on diagnostic testicular biopsy. Obstructive azoospermia may be congenital (congenital absence of the vas deferens, idiopathic epididymal obstruction) or acquired (from infections, vasectomy, or other iatrogenic injuries to the male reproductive tract). Couples in whom the man has congenital reproductive tract obstruction should have cystic fibrosis (CF) gene mutation analysis for the female partner because of the high risk of the male being a CF carrier. Patients with acquired obstruction of the male reproductive tract may be treated using microsurgical reconstruction or transurethral resection of the ejaculatory ducts, depending on the level of obstruction. Alternatively, sperm retrieval with assisted reproduction may be used to effect pregnancies, with success rates of 25–65% reported by different centres. Non-obstructive azoospermia may be treated by defining the cause of low sperm production and initiating treatment. Genetic evaluation with Y-chromosome microdeletion analysis and karyotype testing provides prognostic information in these men. For men who have had any factors potentially affecting sperm production treated and remain azoospermic, sperm retrieval from the testis may be effective in 30–70% of cases. Once sperm are found, pregnancy rates of 20–50% may be obtained at different centres with in vitro fertilisation and intracytoplasmic sperm injection.

Infertility

2017 ◽  
Author(s):  
Oliver Kayes ◽  
Akwasi Amoako
Keyword(s):  
Good Evidence ◽  
Obstructive Azoospermia ◽  
Success Rates ◽  
Sperm Retrieval ◽  
Assisted Reproduction Technologies ◽  
Biological Children ◽  
Variable Success ◽  
Randomized Control

Surgical sperm retrieval combined with the advent of in vitro fertilization and intracytoplasmic sperm injection has enabled many men with obstructive and non-obstructive azoospermia to father their own biological children. Several sperm retrieval techniques have been described to obtain sperm from the vas deferens, epididymis, and testicular parenchyma for use in assisted reproduction technologies. The current techniques have variable success rates but have not been subjected to randomized control trials hence the paucity of good evidence to inform the choice of one technique over the others. In experienced hands, sufficient and good quality sperm can usually be harvested for treatment and/or cryopreservation. This chapter summarizes the current techniques of surgical sperm retrieval, sperm retrieval success rate, and the role of adjuvant therapies in increasing chance of successful sperm retrieval.

scholarly journals Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient

2018 ◽  
Vol 90 (2) ◽  
pp. 130 ◽  
Author(s):  
Elia Maglia ◽  
Luca Boeri ◽  
Matteo Fontana ◽  
Andrea Gallioli ◽  
Elisa De Lorenzis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Serum Levels ◽  
Testicular Sperm Extraction ◽  
Total Testosterone ◽  
Multivariable Logistic Regression Analysis ◽  
Obstructive Azoospermia ◽  
Success Rates ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
The Impact

Objectives: The superiority of microdissection testicular sperm extraction (mTESE) over conventional TESE (cTESE) for men with non-obstructive azoospermia (NOA) is debated. We aimed to compare the sperm retrieval rate (SRR) of mTESE to cTESE and to identify candidates who would most benefit from mTESE in a cohort of Caucasian-European men with primary couple’s infertility. Material and methods: Data from 49 mTESE and 96 cTESE patients were analysed. We collected demographic and clinical data, serum levels of LH, FSH and total testosterone. Patients with abnormal karyotyping were excluded from analysis. Age was categorized according to the median value of 35 years. FSH values were dichotomized according to multiples of the normal range (N) (N and 1.5 N: 1-18 mIU/mL, and > 18 mIU/mL). Testicular histology was recorded for each patient. Descriptive statistics and logistic regression analyses tested the impact of potential predictors on positive SRR in both groups. Results: No differences were found between groups in terms of clinical and hormonal parameters with the exception of FSH values that were higher in mTESE patients (p = 0.004). SRR were comparable between mTESE and cTESE (49.0% vs. 41.7%, p = 0.40). SRRs were significantly higher after mTESE in patients with Sertoli cell-only syndrome (SCOS) (p = 0.038), in those older than 35 years (p = 0.03) and with FSH >1.5N (p < 0.001), as compared to men submitted to cTESE. Multivariable logistic regression analysis showed that mTESE was independent predictor of positive SR in patients older than 35 years (p = 0.002) and with FSH > 1.5N (p = 0.018). Moreover, increased FSH levels (p = 0.03) and both SCOS (p = 0.01) and MA histology (p = 0.04) were independent predictors of SRR failure. Conclusions: Microdissection and cTESE showed comparable success rates in our cohort of patients with NOA. mTESE seems beneficial for patients older than 35 years, with high FSH values, or when SCOS can be predicted. Given the high costs associated with the mTESE approach, the identification of candidates most likely to benefit from this procedure is a major clinical need.

Testicular testosterone and estradiol concentrations and aromatase expression in men with nonobstructive azoospermia

2020 ◽  
Author(s):  
Koji Shiraishi ◽  
Shintaro Oka ◽  
Hideyasu Matsuyama
Keyword(s):  
Leydig Cells ◽  
Close Association ◽  
Therapeutic Window ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Nonobstructive Azoospermia ◽  
Sperm Retrieval ◽  
Aromatase Expression ◽  
Liquid Chromatography Tandem Mass ◽  
Hormonal Milieu

Abstract Context Spermatogenesis is strictly regulated by the intratesticular hormonal milieu, in which testosterone (T) and estradiol (E2) play pivotal roles. However, the optimal expression of aromatase and intratesticular T (ITT) and E2 (ITE2) levels are unknown. Objective To investigate ITT/ITE2 and aromatase expression in men with nonobstructive azoospermia (NOA) and to elucidate the roles of aromatase in spermatogenesis, as determined based on sperm retrieval by microdissection testicular sperm extraction (micro-TESE). Design and setting A retrospective study at a reproductive center using serum, testicular specimens and intratesticular fluid. Patients Seventy-six men with NOA, including four men who received three months of anastrozole administration prior to micro-TESE, and 18 men with obstructive azoospermia. Interventions Testicular aromatase expression was evaluated using immunohistochemistry and quantitative RT-PCR. ITT and ITE2 levels were determined using liquid chromatography-tandem mass spectrometry. Results Aromatase was mainly located in Leydig cells, and the levels of its transcript and protein expression levels were increased in men with NOA. No correlation was observed between serum T/E2 and ITT/ITE2 levels, whereas significant associations were observed between decreased ITT/increased ITE2, aromatase expression and sperm retrieval. Treatment with anastrozole increased the ITT/ITE2 ratio and decreased aromatase expression. Conclusions A close association between the expression of aromatase in Leydig cells and ITT/ITE2 was shown. Leydig cell aromatase is a factor that is independently correlated with spermatogenesis, and aromatase inhibitors may open a therapeutic window by increasing the ITT/ITE2 in selected patients.

Can Testicular Size Be a Predictive Factor for Successful Sperm Retrieval in Patients with Non Obstructive Azoospermia?

2019 ◽  
pp. 1
Author(s):  
Omer Yumusak ◽  
Mehmet Cinar ◽  
Serkan Kahyaoglu ◽  
Yasemin Tasci ◽  
Gul Nihal Buyuk ◽  
...  
Keyword(s):  
Follicle Stimulating Hormone ◽  
Significant Risk ◽  
High Serum ◽  
Testicular Volume ◽  
Testicular Sperm Extraction ◽  
Total Testosterone ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Stimulating Hormone

<p><strong>Objective:</strong> 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.</p><p><strong>Study Design:</strong> 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.</p><p><strong>Results:</strong> 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&lt;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.</p><p><strong>Conclusion:</strong> 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.</p>

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