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

Abstract

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.KEY WORDS: Testicular sperm extraction; Non-obstructive azoospermia; Infertility; Risk factors. SummaryNo conflict of interest declared.

Evaluating the quality of reported outcomes for microsurgical TESE in men with non‐obstructive azoospermia: A methodological analysis

“…SRRs may serve as points of comparison between different operative techniques, which may help surgeons identify more efficacious approaches, as demonstrated by Bernie et al (2015) 17 . Similarly, highlighting predictors of retrieval of any testicular spermatozoa may help identify specific demographics of NOA patients and specific histopathology which are correlated with higher retrieval, as demonstrated by Maglia et al (2018) 71 . However, there is little published consensus on exactly what defines a successful sperm retrieval.…”

Comparison of the Effects of Different Testicular Sperm Extraction Methods on the Embryonic Development of Azoospermic Men in Intracytoplasmic Sperm Injection (ICSI) Cycles: A Retrospective Cohort Study

“…However, some studies have shown that there are no precise and noninvasive methods for predicting whether there are testicular spermatozoa in NOA patients before mTESE [ 10 ]. Maglia et al found that the success rate of sperm retrieval in NOA patients was similar between the mTESE group and the conventional TESA group, and mTESE seemed to be more beneficial for patients over 35 years of age and with high FSH value [ 11 ].…”

Predictive factors for successful sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia and a history of cryptorchidism

“… 6 7 Many studies showed that the sperm acquisition rate of Micro-TESE is higher than that of traditional testicular sperm extraction. 8 For example, Schlegel 9 found that the rates of sperm acquisition (median [interquartile range, IQR]) are 45% (24%–68%) in traditional TESE and 63% (42%–81%) in Micro-TESE. Amer et al .…”