Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes

Abstract

Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l −1 vs 19.3 IU l −1 , P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval ( P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

“…In addition, pregnancy and live birth rates were also similar between the two groups, suggesting the theory a history unilateral cryptorchidism could reflect a bilateral testicular impairment. However, inhibin B level might be a predictor of successful TESE in their series 7 . In another study by Negri et al, sperm retrieval rate was 40% in the patients who had history of bilateral orchidopexy 6 .…”

“…eral versus unilateral cryptorchidism. 7 Sperm retrieval rates were similar between bilateral (60%) and unilateral (66.2%) groups. In addition, pregnancy and live birth rates were also similar between the two groups, suggesting the theory a history unilateral cryptorchidism could reflect a bilateral testicular impairment.…”

“…Barbotin et al compared fertility outcomes between men with bilateral versus unilateral cryptorchidism 7 . Sperm retrieval rates were similar between bilateral (60%) and unilateral (66.2%) groups.…”

“…Testicular sperm retrieval rates have been reported as 49.5 to 74% in azoospermic men with a history of cryptorchidism/orchidopexy. [3][4][5][6][7][8][9] Sperm retrieval rate has been significantly higher in azoospermic patients with a history of cryptorchidism than patients with different etiologies of non-obstructive azoospermia. fertilization, pregnancy, and live birth rates were similar between the two groups.…”

“…Testicular sperm retrieval rates have been reported as 49.5 to 74% in azoospermic men with a history of cryptorchidism or orchidopexy, and some studies have attempted to identify predictors for successful sperm retrieval in this population. [3][4][5][6][7][8][9] However, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series.…”