Serum testosterone levels and other determinants of sperm retrieval in microdissection testicular sperm extraction

Abstract

BackgroundMicrodissection testicular sperm extraction (microTESE) has become the standard of care for sperm retrieval in non-obstructive azoospermia (NOA) patients. Understanding the significant determinants of microTESE outcomes may result in improvements in sperm retrieval rates and provide better-informed clinical decisions.MethodsThis is a clinical retrospective study conducted through chart review of 421 NOA patients who underwent microTESE between August 2009 and July 2015 in a tertiary-care referral hospital. Clinical, biochemical and histopathological characteristics were collected. Normal serum testosterone level was defined as testosterone >9.9 nmol/L. Multiple logistic regression was used to identify determinants of microTESE in the studied population. A P<0.05 was considered significant.ResultsSperms were successfully retrieved in 39.4% of cases. The average testosterone level was 11.51±7.40 and 11.67±6.42 in patients with successful and unsuccessful microTESE, respectively (P=0.820). No significant association was found between serum testosterone level and sperm motility and amount. Of all variables, histological subtype remained to be the most significant determinant of microTESE outcomes in the examined population, with hypospermatogenesis having over a 3-fold higher odd of successful microTESE than sertoli-cell only.ConclusionsSerum testosterone level appears to have no significant association with microTESE outcomes in NOA. The underlying histological pattern is a significant determinant of the procedure’s success.

The seminiferous tubule caliber pattern as evaluated at high magnification during microdissection testicular sperm extraction predicts sperm retrieval in patients with non‐obstructive azoospermia

“…Our data suggest also that when testis histology is coupled to the tubule pattern, SSR is predicted with an excellent diagnostic accuracy (AUC 0.93). Histology has been previously found to be the unique parameter able to predict the outcome of microTESE (Abdel Raheem et al ., ; Bernie et al ., ; Althakafi et al ., ; Li et al ., ), though with a poor/fair diagnostic accuracy (Li et al ., ). The only limit of testis histology is that it may be available when conventional TESE or, in rare cases, testis biopsy has been performed prior to microTESE, but this is not a rare event for NOA patients.…”

A comprehensive assessment of predictors of fertility outcomes in men with non-obstructive azoospermia undergoing microdissection testicular sperm extraction

“…Since the advent of microTESE for NOA due to primary testicular dysfunction, multiple investigators have assessed predictors such as age, testicular volume and FSH levels of various outcomes [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Most of this research has been focused on only the first step for the couple: retrieving sperm.…”

“…It has been established that microdissection testicular sperm extraction (microTESE) allows for retrieval of the largest number of sperm cells for use with in-vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) in men with non-obstructive azoospermia (NOA) with primary testicular dysfunction [3][4][5][6]. A number of studies have assessed potential predictors of sperm retrieval rates in men with NOA who underwent microTESE, such as age, follicle stimulating hormone (FSH) level, and testicular volume on sperm retrieval rates [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. However, there is a paucity of data regarding these factors as predictors of downstream outcomes, such as progression of embryology following IVF/ICSI to reach embryo transfer (ET), clinical pregnancy, live birth, and retrieving surplus sperm for more than the initial IVF/ICSI cycle, which can aid in patient management and counseling.…”

Protamine 1/Protamine 2 mRNA ratio in nonobstructive azoospermic patients

“…All these hormonal changes are due to the fact that primary hypogonadism is associated with low levels of testosterone and high levels of FSH (Alfano et al., 2017). These changes in hormonal levels reflect the decrease in sperm production areas, which shows normal hormonal response and the extent of the pathology present in the testicular tissue (Althakafi et al., 2017). With the increase in the extent of disease in the testicular tissue, more extreme derangements would be in the serum hormonal levels, due to the feedback loops.…”