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.

P–095 Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed TESE in men with non-obstructive azoospermia: results from a multicenter study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Boeri ◽  
D Dente ◽  
E Greco ◽  
M Turetti ◽  
M Capece ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Surgical Techniques ◽  
Testicular Sperm Extraction ◽  
Total Testosterone ◽  
Multivariable Logistic Regression Analysis ◽  
Histopathological Diagnosis ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Baseline Serum

Abstract Study question We assessed the outcome and predictors of successful salvage microdissection testicular sperm extraction (mTESE) in non-obstructive azoospermia (NOA) men previously submitted to unfruitful classic (cTESE). Summary answer The sperm retrieval rate at salvage mTESE was almost 50%. Hypospermatogenesis and low FSH values were associated with positive outcomes at salvage mTESE What is known already In men with NOA testicular sperm can be retrieved using cTESE in approximately 50% of cases. mTESE has been proposed as a salvage treatment option for men with a previously failed TESE, but data are scarce. Study design, size, duration Multicenter, cross-sectional study. Complete data from 61 NOA men who underwent mTESE after a failed cTESE between 01/2014 and 10/2020, at 6 tertiary referral centers in Italy were analysed. Participants/materials, setting, methods All men underwent testicular ultrasound, hormonal and genetic blood testing. Histopathological diagnosis from TESE was collected in every man. Semen analyses were based on the 2010 WHO reference criteria. mTESE was performed according to the technique of Schlegel et al. (1999). Descriptive statistics and logistic regression models were used to investigate potential predictors of positive sperm retrieval (SR+) after salvage mTESE. Main results and the role of chance Overall, median (IQR) age and testicular volume were 35 (31–38) years and 10 (6–15) ml, respectively. Baseline serum FSH and total testosterone levels were 17.1 (8.6–30.4) mUI/mL and 4.7 (3.5–6.4) ng/mL, respectively. Sertoli-cell-only (SCO) syndrome, maturation arrest (MA) and hypospermatogenesis were found in 24 (39.3%), 21 (34.4%) and 16 (26.2%) men after cTESE, respectively. Spermatozoa were retrieved in 30 (49.2%) men at salvage mTESE. Patients with a diagnosis of hypospermatogenesis had a higher rate of SR + [12/16 (75%)] than those with MA [12/21 (57.1%)] and SCOS [6/24 (25%)] after salvage mTESE (p &lt; 0.01), which was bilateral in 36 (59%) cases. FSH was higher [16.5 (8–22) vs. 8.9 (5–13) mUI/mL, p &lt; 0.01] in SR- patients compared to SR+. No difference in clinical characteristics was found between patients with SR+ and SR- at salvage mTESE. There were no significant complications after mTESE. Multivariable logistic regression analysis showed that hypospermatogenesis (OR 9.7; p &lt; 0.01) and low FSH levels (OR 0.9, p &lt; 0.001) were independent predictors of SR+ after salvage mTESE, after accounting for age. Limitations, reasons for caution Despite we analysed one of the largest series of salvage mTESE, the samples size is too small to draw general conclusions. Because of the multicenter nature of the study we cannot rely on standardization of surgical techniques for TESE. Wider implications of the findings: This is one of the larger studies on salvage mTESE. The selection of patients for salvage mTESE is of critical importance. Trial registration number na

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>

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

2018 ◽  
Vol 85 (2) ◽  
pp. 60-67 ◽  
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.

scholarly journals How Successful Is Surgical Sperm Retrieval in Klinefelter Syndrome?

2021 ◽  
Vol 3 ◽  
Author(s):  
Yamini Kailash ◽  
Amr Abdel Raheem ◽  
Sheryl T. Homa
Keyword(s):  
Operative Time ◽  
Klinefelter Syndrome ◽  
Successful Outcome ◽  
Testicular Sperm Extraction ◽  
Success Rates ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Future Fertility ◽  
Reproductive Endocrine ◽  
The Impact

Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). This review article summarizes the success rates of the available techniques for surgical sperm retrieval (SSR) in KS including conventional testicular sperm extraction (cTESE) and micro testicular sperm extraction (mTESE), as well as the risks of these procedures for future fertility. The evidence indicates that the SSR rate is as successful in non-mosaic men with KS as those with normal karyotypes, with retrieval rates of up to 55% reported. The influence of different factors that affect the chances of a successful outcome are discussed. In particular, the impact of aneuploidy rate, physical characteristics, co-morbidities, reproductive endocrine balance and the use of different hormone management therapies are highlighted. Evidence is presented to suggest that the single most significant determinant for successful SSR is the age of the patient. The success of SSR is also influenced by surgical technique and operative time, as well as the skills of the surgeon and embryology team. Rescue mTESE may be used successfully following failed TESE in KS patients in combination with hormone stimulation.

Administration of pharmaceutical agents prior to testicular sperm extraction procedures: A meaningful or meaningless approach?

2020 ◽  
Vol 26 ◽  
Author(s):  
Selahittin Çayan ◽  
Onder Yaman
Keyword(s):  
Hormonal Treatment ◽  
Controlled Study ◽  
Testicular Sperm Extraction ◽  
Total Testosterone ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Normal Range ◽  
Sperm Retrieval ◽  
Adjuvant Hormonal Treatment ◽  
Pharmaceutical Agents

Background: To date, no randomized and controlled study has demonstrated effect of adjuvant medical therapy on testicular sperm production before the sperm retrieval procedures in men with non-obstructive azoospermia (NOA). Objectives: To present the available data on administration of pharmaceutical agents prior to testicular sperm extraction (TESE) procedures in order to obtain better sperm retrieval results in men with NOA. Methods and Results: Various pharmaceutical agents used empirically to induce spermatogenesis in the treatment of NOA. The rationale for adjuvant hormonal treatment has been to increase intratesticular testosterone levels with different dosages of gonadotropins, anti-estrogen agents or aromatase inhibitors. Conclusion: Based on the published studies, in the presence of normal range of peripheral serum total testosterone level, no medical treatment is advised, and TESE procedures should be performed directly in men with NOA. Further well-designed and randomized, placebo controlled trials are needed to support the potential benefit of pretreatment prior to TESE procedures.

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

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.

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

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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