Faculty Opinions recommendation of Conventional testicular sperm extraction (TESE) and non-obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non-academic community hospital.

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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Endocrine Follow-Up of Men with Non-Obstructive Azoospermia Following Testicular Sperm Extraction

Journal of Clinical Medicine ◽

10.3390/jcm10153323 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3323

Author(s):

Evangelia Billa ◽

George A. Kanakis ◽

Dimitrios G. Goulis

Keyword(s):

Klinefelter Syndrome ◽

Term Treatment ◽

Testicular Sperm Extraction ◽

Total Testosterone ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Cell Dysfunction ◽

Long Term Treatment ◽

Biological Parenthood

Testicular sperm extraction (TESE) is a surgical procedure which, combined with intracytoplasmic sperm injection, constitutes the main treatment for achieving biological parenthood for patients with infertility due to non-obstructive azoospermia (NOA). Although it is effective, TESE procedures might cause structural testicular damage leading to Leydig cell dysfunction and, consequently, temporary or even permanent hypogonadism with long-term health consequences. To a lesser extent, the same complications have been reported for microdissection TESE, which is considered less invasive. The resulting hypogonadism is more profound and of longer duration in patients with Klinefelter syndrome compared with other NOA causes. Most studies on serum follicle-stimulating hormone and luteinizing hormone concentrations negatively correlate with total testosterone concentrations, which depends on the underlying histology. As hypogonadism is usually temporary, and a watchful waiting approach for about 12 months postoperative is suggested. In cases where replacement therapy with testosterone is indicated, temporary discontinuation of treatment may promote the expected recovery of testosterone secretion and revise the decision for long-term treatment.

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Factors Influencing the Decision for Fresh Versus Cryopreserved Microdissection Testicular Sperm Extraction for Non-Obstructive Azoospermia

Urology ◽

10.1016/j.urology.2021.07.016 ◽

2021 ◽

Author(s):

Kian Asanad ◽

R. Matthew Coward ◽

Akanksha Mehta ◽

James F Smith ◽

Sarah C Vij ◽

...

Keyword(s):

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Factors Influencing

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Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Hong Kong Medical Journal ◽

10.12809/hkmj154710 ◽

2016 ◽

Author(s):

Jennifer KY Ko ◽

◽

Joyce Chai ◽

Vivian CY Lee ◽

Raymond HW Li ◽

...

Keyword(s):

Hong Kong ◽

Pregnancy Rate ◽

In Vitro Fertilisation ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Retrieval Rate ◽

Infertile Couples

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Predictive Factors for Sperm Retrieval in Males With Non-obstructive Azoospermia

10.21203/rs.3.rs-613454/v1 ◽

2021 ◽

Author(s):

Wei-Hsun Hsu ◽

Marcelo Chen ◽

Pai-Kai Chiang ◽

Wei-Kung Tsai ◽

Allen W Chiu ◽

...

Keyword(s):

Sertoli Cell ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Testicular Volume ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Retrieval Rate ◽

Normal Spermatogenesis

Abstract The aim of the current study was to investigate the predictive markers for males with non-obstructive azoospermia (NOA) before they received conventional testicular sperm extraction (cTESE) or microdissection testicular sperm extraction (microTESE). Between January 2010 and December 2020, a total of 56 patients who received cTESE or microTESE surgery at the Urology department of the MacKay Memorial Hospital were included. Our univariate analysis revealed that the following parameters was associated with sperm retrieval: Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testicular volume, histopathology of maturation arrest and Sertoli cell-only. The multivariate analysis showed that Sertoli cell-only was significantly less likely to harvest spermatozoa than normal spermatogenesis (OR = 0.03 (0.002-0.42); p = 0.01). A comparison of cTESE and microTESE revealed that the overall successful sperm retrieval rate was not significantly different between the two methods (74.1% vs. 58.6, p = 0.22). This study demonstrated that lower levels of FSH, LH and prolactin, and a higher testicular volume and better histopathology were associated with a higher sperm retrieval rate in the univariate analysis. In the multivariable analysis, only Sertoli cell-only syndrome appeared to have a significantly negative effect on the successful harvesting of sperm when compared with normal spermatogenesis.

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