Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Caroppo, Ettore; Colpi, Elisabetta M; Gazzano, Giacomo; Vaccalluzzo, Liborio; Scroppo, Fabrizio Ildefonso; D’Amato, Giuseppe; Colpi, Giovanni M.

doi:10.1007/s10815-016-0812-3

Cited by 65 publications

(38 citation statements)

References 23 publications

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“…Our outcomes are consistent with previous studies showing the superiority of mTESE over cTESE in SR outcomes for SCOS men (4,6). Similarly, the significant association between both SCOS and MA and sperm retrieval failure has been previously reported (6,19). It can be concluded that progressively worse histological patterns are associated with lower retrieval results.…”

Section: Discussionsupporting

confidence: 92%

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

Maglia

Boeri

Fontana

et al. 2018

Arch Ital Urol Androl

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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.

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Section: Discussionsupporting

confidence: 92%

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

Maglia

Boeri

Fontana

et al. 2018

Arch Ital Urol Androl

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“…The criteria for the diagnosis of NOA were similar to those applied in a previous study from our group (Caroppo et al ., ). Briefly, patients were defined to have NOA if semen analysis showed azoospermia without spermatozoa in the pellet, ejaculate volume and pH were higher than 1 mL and 7.2, respectively, and no sign of obstruction of the seminal tract was detected on physical examination, scrotal, and transrectal ultrasound.…”

Section: Methodsmentioning

confidence: 97%

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

Caroppo¹,

Colpi

Gazzano

et al. 2018

Andrology

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Background: microTESE proved to be the gold standard surgical approach for patients with non-obstructive azoospermia (NOA), but sperm retrieval rates (SRRs) vary considerably among centers. Some authors compared their SRRs with the pattern of seminiferous tubule caliber found at high magnification, but none provided diagnostic accuracy measures. Objective: The present retrospective study sought to verify the diagnostic accuracy of the pattern of seminiferous tubule caliber in predicting the sperm retrieval in NOA patients. Materials and Methods: Data from 143 infertile NOA men undergoing unilateral (64) or bilateral (79) microTESE (222 testes) were retrospectively evaluated. During microTESE, if present, dilated tubules (DTs) were retrieved, otherwise tubules with slightly larger caliber (SDT) (924) than that of the surroundings were removed. When no DT or SDT were found, not dilated tubules (NDTs) were excised. Results: Spermatozoa were retrieved in 95 of 222 testes (42.8%); sperm retrieval was successful in 90% of testes with DTs, in 47% of those with SDTs, and only in 7% of those with NDTs (p < 0.0001). Stepwise binary logistic regression revealed that the combination of seminiferous tubule pattern and testis histology was significantly predictive of SSR, being able to classify 86.8% of testes, with an excellent diagnostic accuracy (AUC 0.93). The median number of spermatozoa retrieved was significantly higher in DTs compared with SDTs and NDTs. Discussion: The results of the present study provide reliable accuracy measures in support of the relationship between seminiferous tubule caliber pattern and SSR in patients with non-obstructive azoospermia. We are proposing for the first time that spermatozoa may be retrieved even from slightly dilated tubules in about half of cases. The pattern of tubules retrieved, together with histology, may represent an additional outcome measure of microTESE. Conclusion: The pattern of seminiferous tubules together with testis histology predicts sperm retrieval with an excellent diagnostic accuracy. SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article.Table S1 Clinical parameters as stratified per tubules caliber pattern.

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“…Therefore, we considered the chance of sperm recovery as drastically reduced to the minimum, so to recommend at first a heterologous fertilisation, but the patient was particularly motivated to father an own biological child. As widely demonstrated in previous studies (Caroppo et al., ; Seo & Ko, ; Weedin, Bennett, Fenig, Lamb, & Lipshultz, ; Yang et al., ), the histopathological patterns could be considered as a predictive factor of SR. Accordingly, the possibility of SR is higher in patients with hypospermatogenesis compared with patients with MA and SCOS.…”

Section: Discussionmentioning

confidence: 63%

“…Caroppo et al. affirmed that patients with SSR had significantly lower serum FSH level (in mean 16.1 IU/L) and higher testicular volume (8.7 ml) compared with sperm retrieval failure, in which FSH value had an average of 22.4 IU/L and a testis volume had a mean of 7.2 ml (Caroppo et al., ).…”

Section: Discussionmentioning

confidence: 99%

Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review

et al. 2018

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Azoospermia can be diagnosed in about 10%-15% of the infertile male population. To overcome the problem of failure to produce spermatozoa in the ejaculate in patients with nonobstructive azoospermia (NOA), testicular sperm extraction (TESE) may be performed to find the focal area of spermatogenesis. A 47-year-old man with NOA presented for treatment of secondary couple infertility. The patient underwent a first TESE 7 years earlier with cryopreservation, and an intracytoplasmic sperm injection-embryo transfer ended in a term pregnancy. He reported a history of repeated testicular traumas. At the present time, a complete medical workup was carried out, including clinical history, general and genital physical examination, scrotal and transrectal ultrasounds. Hormone measurements showed follicle-stimulating hormone level of 42.7 IU/L, luteinising hormone of 11.4 IU/L, total testosterone of 2.6 ng/ml and right and left testicular volume, respectively, of 4 and 3.9 ml. He underwent a second TESE, with successful sperm retrieval and cryopreservation. The histological pattern was hypospermatogenesis. In cases of extreme testicular impairment, although in the presence of very high follicle-stimulating hormone value and small testicular volume, estimating poor sperm recovery potential, the integration of clinical and anamnestic data, could help the surgeon to practise the more appropriate method of treatment.

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Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Cited by 65 publications

References 23 publications

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

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

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

Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review

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