Predictive factors of successful microdissection testicular sperm extraction

Abstract

Azoospermia in men requires microsurgical reconstruction or a procedure for sperm retrieval with assisted reproduction to allow fertility. While the chance of successful retrieval of sperm in men with obstructive azoospermia approaches >90%, the chances of sperm retrieval in men with non-obstructive azoospermia (NOA) are not as high. Conventional procedures such as fine needle aspiration of the testis, testicular biopsy and testicular sperm extraction are successful in 20–45% of men with NOA. With microdissection testicular sperm extraction (micro-TESE), the chance of successful retrieval can be up to 60%. Despite this increased success, the ability to counsel patients preoperatively on their probability of successful sperm retrieval has remained challenging. A combination of variables such as age, serum FSH and inhibin B levels, testicular size, genetic analysis, history of Klinefelter syndrome, history of cryptorchidism or varicocele and histopathology on diagnostic biopsy have provided some insight into the chance of successful sperm retrieval in men with NOA. The goal of this review was to evaluate the preoperative factors that are currently available to predict the outcome for success with micro-TESE.

Outcome of testicular sperm extraction in nonmosaic Klinefelter syndrome patients: what is the best approach?

“…There is no doubt that testicular volume has been considered as a reflection of testicular function (Bernie et al, 2013). Schoor et al (2002) expected NOA in men who have a testicular long axis of 4.6 cm or less.…”

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

“…The necessity of prior diagnostic biopsy is still controversial in the literature [19–21]. In some clinics, prior diagnostic testicle biopsy was carried out to ensure presence of sperm or for the treatment of patients with NOA [22].…”

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

“…31 In a meta-analysis, serum inhibin B had a sensitivity of 0.65 and a specificity of 0.83 in prediction of successful TESE but it was still suboptimal as a single predictive criterion. 33 Seminal anti-Müllerian hormone and inhibin B are secreted by the Sertoli cells into the seminiferous tubules and therefore in theory are more direct markers of spermatogenesis, but their predictive value for successful TESE was not confirmed in a prospective study of 139 men with NOA by Mitchell et al 34 A combination of factors have been shown to fare better, and authors have described the use of a predictive score involving the total testicular volume, FSH, and inhibin B to predict the sperm retrieval rate in NOA.…”

“…28 Indeed, no individual biochemical or hormonal marker has been found to reliably predict success in TESE. 31 Although histopathology of testicular biopsy has been shown to predict TESE outcome, it is invasive and usually done at the time of TESE itself rather than beforehand in many patients, limiting its role as a predictive marker. 31 The detection of Y chromosome microdeletion, especially AZFa and AZFb, was important to guide prognosis as discussed above.…”

“…31 Although histopathology of testicular biopsy has been shown to predict TESE outcome, it is invasive and usually done at the time of TESE itself rather than beforehand in many patients, limiting its role as a predictive marker. 31 The detection of Y chromosome microdeletion, especially AZFa and AZFb, was important to guide prognosis as discussed above. Ramasamy et al 32 showed that high serum FSH level in men did not affect the success of microdissection TESE and should not be used to deny men the possibility to father a child with their own genetic material.…”