Hormonal Status and Sperm Parameters in Patients with Microsurgery for Non-Obstructive Azoospermia

Abstract

Azoospermia occurs in approximately 10% of men with infertility and can occur due to obstruction of the reproductive tract (obstructive azoospermia) or lack of sperm production. Assessing the hormonal status of men can provide prognostic information on the effectiveness of surgical sperm removal for their further use in assisted reproductive technology programs. Before performing a testicular biopsy to establish a histological diagnosis and search for sperm in patients with non-obstructive azoospermia, it is advisable to assess the chances of obtaining sperm. The purpose of the study was to assess hormonal levels and sperm parameters during microsurgery in men with non-obstructive azoospermia. Material and methods. We analyzed the medical records of 45 men with non-obstructive azoospermia who underwent micro-TESE in the period from 2016 to 2019. We noted the data on the age of patients, their hormonal profile (level of follicle-stimulating hormone, luteinizing hormone and testosterone) were analyzed and morphofunctional characteristics of the obtained spermatozoa. Results and discussion. In our study, testosterone levels were significantly higher in patients in group 1, which may be due to the fact that men in this group were significantly younger. Sperm were removed from 10 (22%) patients with non-obstructive azoospermia. The probability of sperm removal decreased with increasing age of patients. The average concentration of sperm in the samples was (2.3±0.8) million, of which active (18.0±0.3)%. Morphological analysis of sperm revealed that the frequency of abnormalities of the head was 19.9±2.45, neck – 13.69±1.49, tail – (5.96±1.52)%. Mixed pathology, which involved defects of the head, neck and middle part were at the level of (34.6±4.21)%. The frequency of sperm neck abnormalities was (13.7±1.5)%. The most numerous were abnormalities associated with the presence of cytoplasmic residues on the surface of the sperm. The number of sperm with tail pathology was at the level of (5.9±1.5)%. In general, the mixed pathology, in which defects of the head, neck and middle part were involved, was at the level of (34.6±4.2)%. Conclusion. In this study, the frequency of positive micro-TESE, i.e. surgical procedures after which sperm were removed, was 22.2%. Morphological analysis of the drugs revealed that among the identified pathologies, most of them were sperm with the presence of one large or several small vacuoles. The number of vacuoles, their size and shape reflect defects at the level of compaction of the sperm nucleus. It has been shown that embryos formed after fertilization of oocytes with such sperm do not undergo reproductive selection and can stop in the early stages of development