Microdissection testicular sperm extraction (micro‐TESE): Predictive value of preoperative hormonal levels and pathology in non‐obstructive azoospermia

Abstract

The aim of this study was to evaluate the predictive value of preoperative hormonal levels and pathology, as well as the outcome of microsurgical testicular sperm extraction in patients with non-obstructive azoospermia (NOA), presenting to our clinic for treatment of infertility. The records of 145 men with NOA who underwent microdissection testicular sperm extraction (micro-TESE) between March 2013 and November 2016 were studied. The patient's age, testicular volume, hormonal profile for follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT), and testicular pathology were recorded. The sperm retrieval, the clinical pregnancy and live birth delivery rates were noted. Our testicular sperm retrieval rate was 65.5%. There was no statistical difference in age, testicular volume, or hormonal levels in the TESE-positive and negative groups. Hypospermatogenesis was found in testicular histopathology in 57 of 117 patients (48.7%) who underwent testicular biopsy. Sertoli Cell-Only (SCO) syndrome was seen in 20.5%, Germ Cell Maturation Arrest (MA) in 16.3%, and Atrophy-hyalinization in 14.5%. Seven men had Klinefelter's syndrome (KS), four of whom were TESE-positive. There were no adverse effects of the procedure except for infection at the incision site in one patient. Single intracytoplasmic sperm injection (ICSI) cycles were performed in 92 couples leading to 41 clinical pregnancies and 26 live birth deliveries. Micro-TESE is a safe procedure in experienced hands and provides infertile men with NOA an opportunity to father children. However unselected candidates with NOA should be counselled at the outset that only 17.9% will eventually become biological fathers.

Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men

“…The rate of sperm retrieval from hypospermatogenetic testis in our study is lower than those indicated in literature. [15,16] This is because the other factors (testicular volume, hormone profile, etc.) related to the testes were lower in these patients, and they were subject to recurrent mTESE operations.…”

Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia

“…In addition, they obtained cutoff points of 400 ng/mL for total testosterone and 11 pg/mL for free testosterone with predictive accuracies of 37.7% and 35.5%, respectively. By contrast, the majority of studies analyzed both total and free levels of serum testosterone in the aforementioned groups of patients did not corroborate this statistically significant difference between the groups and therefore have concluded that serum testosterone lacks any value in predicting sperm retrieval rate by TESE operation [14,18,19,23,27,30]. Moreover, in reports which proposed testosterone as a predictive biomarker, serum testosterone level either acts as a part of a multivariate model or lacks sufficient sensitivity and specificity required for clinical application.…”

“…Similarly, Bonarriba et al [25] have introduced the cutoff point of 12.2 mIU/mL for serum FSH with sensitivity and specificity of 71% and 75%, respectively. Nevertheless, it is generally accepted that the serum FSH has a poor value for predicting the existence of sperm in the testes [27,28,30]. Indeed, cases with even serum FSH > 90 mIU/mL but positive TESE outcomes have been observed in previous studies [21].…”

“…Most studies that investigated serum LH concentration with TESE outcome have found no significant difference in LH levels between patients with and without successful TESE outcome and hence did not consider any predictive value for serum LH level [12,14,18,23,27,30]. By contrast, Cetinkaya et al [16] have reported significantly lower levels AUC area under the curve, NA not available or applicable *Between groups of men with positive and negative sperm retrieval § Including patients with both obstructive and non-obstructive azoospermia † Surprisingly, higher values were significantly associated with greater chance of sperm recovery of serum LH in men with positive sperm retrieval compared to those with negative sperm retrieval.…”

Sterility, an Overlooked Health Condition

“…Another example in which futility was determined involved a male partner who lacked viable spermatozoa. A determination of futility is also inappropriate because multiple studies indicate that treatment chances can be as high as 25% and 36% [66][67][68]. Another example involved a couple who underwent numerous IVF cycles without adequate egg production, fertilization, or embryo development.…”