SPERM RETRIEVAL AND PREGNANCY OUTCOME FOR AZOOSPERMIC INFERTILE MEN

Abstract Study question What is the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and non obstructive azoospermia (NOA)? Summary answer In hypogonadal men there is a positive correlation between change of serum Testosterone (ΔT) before and after stimulation, and a successful mTESE. What is known already NOA is the most common cause of azoospermia and it is often associated with hypogonadism and testicular failure. It is common practice for endocrine stimulation therapies such as gonadotropines or selective estrogens receptor modulators to be used prior mTESE; however there is currently paucity of data regarding their efficacy. Study design, size, duration Retrospective analysis on infertile men with hypogonadism (defined as T < 12nmol/L) and NOA who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or human chorionic gonadotropin). Retrospective data from 2015–2020, total number of patient: 71; stimulated group (N:40) vs unstimulated group (N:31). Participants/materials, setting, methods Retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy. Hypogonadism was defined as serum testosterone (T) level <12nm/L. We recorded demographic data, cause of testicular failure, previous testosterone therapy, duration and type of endocrine stimulation, pre-and post-stimulation hormone levels(T, FSH, LH), pre-operative hormone levels, successful sperm retrieval rate (at least 1 vial of viable sperm), average Johnsen score and total number of vials of sperm retrieved. Main results and the role of chance One-hundred-sixty-eight men underwent mTESE out of which 59 men received endocrine stimulation therapy for NOA between 2015–2020. Among them, we selected men with hypogonadism defined as serum T < 12nmol/L which comprised 43% of the entire patient cohort. The hypogonadal group included 71 men, 28/71 had Klinefelter syndrome and 40/71 received endocrine stimulation for 13.9±9.2 months. Testosterone levels significantly increased after endocrine stimulation (6.3±3.3nm/L vs 11.7±7.4nm/L) with mean change in serum testosterone (ΔT) of 5.7 nm/L (–5.5–23.3, N35). In the stimulated group, pre-operative serum T levels were significantly higher (11.7±7.4 vs 7.8±3.0 p:0.007) as compared to unstimulated men but the success rate of mTESE did not differ significantly (16/40–40%) vs 13/31–42%). Men with Klinefelter syndrome demonstrated significant differences with regards to age, lower T levels, higher FSH and LH levels, lower Johnsen score and success rates compared to other causes of NOA. Comparing men who had successful mTESE vs unsuccessful mTESE - higher T and lower FSH and LH seemed to correlate with successful sperm retrieval. Among men who received endocrine stimulation therapy the ΔT before and after stimulation seemed to correlate with successful sperm retrieval (AUC:0.701, SE:0.089, p:0.043). In the stimulated group a ΔT>3.5nm/L showed a significant association with successful mTESE(p:0.041). Limitations, reasons for caution Retrospective study limitations. Wider implications of the findings: Our study shows a significant improvement of serum T following endocrine stimulation therapy. Overall, in hypogonadal men, the hormonal stimulation seems not to be related to a higher success rate of mTESE but our data do suggest a positive correlation between ΔT before and after stimulation, and a successful mTESE. Trial registration number Not applicable

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A modification of Johnson score as predictive value of sperm retrieval in non-obstructive azoospermia infertile men

10.1063/1.5096723 ◽

2019 ◽

Author(s):

Silvia W. Lestari ◽

Debby Aditya ◽

Gita Pratama ◽

Kanadi Sumapradja ◽

Ria Margiana

Keyword(s):

Predictive Value ◽

Obstructive Azoospermia ◽

Sperm Retrieval ◽

Infertile Men

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Novel use of fine needle aspiration of seminal vesicles for sperm retrieval in infertile men

Urology ◽

10.1016/j.urology.2005.03.075 ◽

2005 ◽

Vol 66 (4) ◽

pp. 880.e11-880.e12 ◽

Cited By ~ 5

Author(s):

Dominik Boehlen ◽

Hans-Peter Schmid

Keyword(s):

Fine Needle Aspiration ◽

Needle Aspiration ◽

Seminal Vesicles ◽

Sperm Retrieval ◽

Fine Needle ◽

Infertile Men

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Comparison of three sperm retrieval techniques in spinal cord-injured men: Pregnancy outcome

Gynecological Endocrinology ◽

10.1080/09513590600647326 ◽

2006 ◽

Vol 22 (5) ◽

pp. 252-255 ◽

Cited By ~ 11

Author(s):

Yaprak Engin-Üstün ◽

Cem Korkmaz ◽

Namik Kemal Duru ◽

İskender Başer

Keyword(s):

Spinal Cord ◽

Pregnancy Outcome ◽

Sperm Retrieval ◽

Spinal Cord Injured

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O-150 Predicting the sperm retrieval of microsurgical testicular sperm extraction (mTESE) in infertile men with azoospermia on the day of TESE-ICSI

Human Reproduction ◽

10.1093/humrep/deab127.018 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

S F Kappes ◽

S Kliesch ◽

F Macke ◽

V Nordhoff

Keyword(s):

Standard Procedure ◽

Testicular Sperm Extraction ◽

Sperm Number ◽

Testicular Sperm ◽

Male Factor ◽

Sperm Retrieval ◽

Retrieval Rate ◽

Infertile Men ◽

Processed Sample ◽

The Absolute

Abstract Study question Is the sperm retrieval rate of a small, pre-processed sample (PPS) of each TESE-biopsy representative for the sperm outcome on the day of ICSI? Summary answer The analysis of a PPS reliably reflects the probability of finding comparable numbers of sperm at time of TESE-ICSI. What is known already Azoospermia is defined as a condition where no spermatozoa are found in the ejaculate and is diagnosed in up to 15% among infertile men and in 11% of all patients attending our centre. The combination of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) has become the standard treatment of azoospermic patients. However, no validated standard procedure has been identified to predict the exact sperm outcome of the cryopreserved TESE samples prior to TESE-ICSI so far. For optimal management of TESE-biopsies and the respective ICSI treatment, we developed a stepwise approach for the analysis of tissue samples. Study design, size, duration We retrospectively analysed the outcome of 872 microsurgically retrieved testicular biopsies of 198 patients of legal age who had a TESE-ICSI at our department between 2009 and 2019. From all 872 mTESE biopsies the number of sperm extracted from a small, pre-processed sample (PPS) before freezing procedure were known. The PPS was then compared to the number of sperm retrieved from the corresponding thawed specimen on the day of TESE-ICSI. Participants/materials, setting, methods During micro-TESE eight samples per testis are retrieved, then 1/10 of each biopsy is removed, digested with collagenase and screened for spermatozoa (pre-processed sample, PPS). If less than 100 spermatozoa are detected the absolute sperm number is recorded, otherwise the result is displayed as the maximum value of 100 sperm. On the day of ICSI, one or more TESE biopsies are thawed and processed for TESE-ICSI; the absolute sperm number is counted again. Main results and the role of chance Comparing the sperm yield of 872 TESE samples at time of ICSI to its respective PPS showed a similar sperm outcome with a minor deviation of ± 5 spermatozoa in 73.6% of all biopsies. However, 12.9% of the specimen had less and 13.4% had more spermatozoa. A negative sperm retrieval in the initial PPS was confirmed in 93.1% (268/288). PPS with 1-4 spermatozoa had a 27.2% (43/158) risk of complete absence of sperm on the day of ICSI, yet sperm detection (≥1 sperm) was positive in 72.8% (115/158) of the biopsies. With initially ≥5 spermatozoa present in the PPS, only 0.9% (4/426) of the biopsies had no sperm on the day of ICSI, vice versa 99.1% (422/426) were spermatozoa positive. A significant (p = 0.01) and strong (rs = 0.926) correlation of the sperm retrieval rates of the PPS and the ICSI sample was found meaning that the PPS reflects very well the sperm retrieval rate of the cryopreserved mTESE biopsy thawed at time of TESE-ICSI. However, if ≤ 4 sperm are found in the PPS, there is a relevant risk for a negative sperm retrieval on the day of ICSI and the couple should be carefully advised before start of treatment. Limitations, reasons for caution This analysis focussed on sperm prediction in cases of severe male factor infertility and therefore the sperm yield on the day of ICSI was chosen as primary outcome. The reproductive competence of the retrieved sperm in terms of pregnancy and birth rates should be subject to further investigation. Wider implications of the findings Treatment options for azoospermic patients are mostly related to the ability to find sperm on the day of ICSI. However, validated standards for sperm processing are missing. Therefore, a PPS seems to be a good option for prediction of sperm retrieval and improves counselling of the patients prior to TESE-ICSI. Trial registration number not applicable

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Reproductive Chances of Men with Azoospermia Due to Spermatogenic Dysfunction

Journal of Clinical Medicine ◽

10.3390/jcm10071400 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1400

Author(s):

Caroline Kang ◽

Nahid Punjani ◽

Peter N. Schlegel

Keyword(s):

Intracytoplasmic Sperm Injection ◽

Radiation Treatment ◽

Genetic Disorders ◽

Significant Proportion ◽

Severe Form ◽

Obstructive Azoospermia ◽

Sperm Retrieval ◽

Infertile Men ◽

Structural Abnormalities ◽

Infection And Inflammation

Non-obstructive azoospermia (NOA), or lack of sperm in the ejaculate due to spermatogenic dysfunction, is the most severe form of infertility. Men with this form of infertility should be evaluated prior to treatment, as there are various underlying etiologies for NOA. While a significant proportion of NOA men have idiopathic spermatogenic dysfunction, known etiologies including genetic disorders, hormonal anomalies, structural abnormalities, chemotherapy or radiation treatment, infection and inflammation may substantively affect the prognosis for successful treatment. Despite the underlying etiology for NOA, most of these infertile men are candidates for surgical sperm retrieval and subsequent use in intracytoplasmic sperm injection (ICSI). In this review, we describe common etiologies of NOA and clinical outcomes following surgical sperm retrieval and ICSI.

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Endocrine Tests and/or Testicular Volume are Not Predictive of Successful Sperm Retrieval by Conventional Multiple Testicular Sperm Extraction in Nonobstructive Azoospermia

Fertility & Reproduction ◽

10.1142/s266131822050019x ◽

2020 ◽

pp. 1-8

Author(s):

Minh Tam Le ◽

Thi Thanh Tam Nguyen ◽

Dac Nguyen Nguyen ◽

Thi Nhu Quynh Tran ◽

Vu Quoc Huy Nguyen

Keyword(s):

Descriptive Analysis ◽

Multivariable Analysis ◽

Testicular Volume ◽

Testicular Sperm Extraction ◽

Nonobstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Infertile Men ◽

Sperm Aspiration ◽

Significant Difference

Objectives: This study aimed to determine the role of presurgical markers in the prediction of sperm retrieval by conventional Multiple Testicular Sperm Extraction in infertile Vietnamese men with nonobstructive azoospermia (NOA). Patients and Methods: Retrospective descriptive analysis of 136 infertile men with azoospermia, examined from August 2014 to July 2018. Patients underwent stepwise surgical sperm retrieval via percutaneous epididymal sperm aspiration, testicular sperm aspiration, then conventional multiple testicular sperm extraction in up to three locations, and procedures stopped as soon as sperm were detected. Factors were analyzed to determine the prediction of the likelihood of successful sperm retrieval, in men with NOA. Results: The overall success rate of sperm retrieval in men with azoospermia was 49.3%, but it was only 18.4% in NOA group. The difference in testicular volume between men with successful sperm retrieval and unsuccessful sperm retrieval was not statistically significant in NOA group (5.68 ± 2.37 vs. 4.46 ± 2.83, p = 0.138). The differences in the endocrine tests between the two groups were also not significant in terms of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (p ¿ 0.05). Multivariable analysis of predictive factors of sperm retrieval in NOA groups found no significant difference, except testicular density (p = 0.015). Conclusions:In infertile men with NOA, neither an endocrine test nor testicular volume should be used for predicting the results of surgical sperm retrieval by conventional multiple testicular sperm extraction.

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