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Vloeberghs V, De Munck N, Racca A, Mateizel I, Wouters K, Tournaye H. Enzymatic tissue processing after testicular biopsy in non-obstructive azoospermia enhances sperm retrieval. Hum Reprod Open 2023; 2023:hoad039. [PMID: 37936829 PMCID: PMC10627277 DOI: 10.1093/hropen/hoad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
STUDY QUESTION What is the added value of enzymatic processing of testicular biopsies on testicular sperm retrieval (SR) rates for patients with non-obstructive azoospermia (NOA)? SUMMARY ANSWER In addition to mechanical mincing, enzymatic digestion increased SR rates in testicular biopsies of NOA patients. WHAT IS KNOWN ALREADY Many studies focus on the surgical approach to optimize recovery of testicular sperm in NOA, and in spite of that, controversy still exists about whether the type of surgery makes any difference as long as multiple biopsies are taken. Few studies, however, focus on the role of the IVF laboratory and the benefit of additional lab procedures, e.g. enzymatic digestion, in order to optimize SR rates. STUDY DESIGN SIZE DURATION This retrospective single-center cohort study included all patients who underwent their first testicular sperm extraction (TESE) by open multiple-biopsy method between January 2004 and July 2022. Only patients with a normal karyotype, absence of Y-q deletions and a diagnosis of NOA based on histology were included. The primary outcome was SR rate after mincing and/or enzymes. The secondary outcome was cumulative live birth (CLB) after ICSI with fresh TESE and subsequent ICSI cycles with frozen TESE. PARTICIPANTS/MATERIALS SETTING METHODS Multiple biopsies were obtained from the testis, unilaterally or bilaterally, on the day of oocyte retrieval. Upon mechanical mincing, biopsies were investigated for 30 min; when no or insufficient numbers of spermatozoa were observed, enzymatic treatment was performed using Collagenase type IV. Multivariable regression analysis was performed to predict CLB per TESE by adjusting for the following confounding factors: male FSH level, female age, and requirement of enzymatic digestion to find sperm. MAIN RESULTS AND THE ROLE OF CHANCE We included 118 patients, of whom 72 (61.0%) had successful SR eventually. Spermatozoa were retrieved after mechanical mincing for 28 patients (23.7%; 28/118) or after additional enzymatic digestion for another 44 patients (37.2%; 44/118). Thus, of the 90 patients requiring enzymatic digestion, sperm were retrieved for 44 (48.9%). Male characteristics were not different between patients with SR after mincing or enzymatic digestion, in regard to mean age (34.5 vs 34.5 years), testis volume (10.2 vs 10.6 ml), FSH (17.8 vs 16.9 IU/l), cryptorchidism (21.4 vs 34.1%), varicocele (3.6 vs 4.6%), or histological diagnosis (Sertoli-cell only 53.6 vs 47.7%, maturation arrest 21.4 vs 38.6%, sclerosis/atrophy 25.0 vs 13.6%).Of the 72 patients with sperm available for ICSI, 23/72 (31.9%) achieved a live birth (LB) after the injection with fresh testicular sperm (and fresh or frozen embryo transfers). Of the remaining 49 patients without LB, 34 (69.4%) had supernumerary testicular sperm frozen. Of these 34 patients, 19 (55.9%) continued ICSI with frozen testicular sperm, and 9/19 (47.4%) had achieved an LB after ICSI with frozen testicular sperm. Thus, the total CLB was 32/118 (27.1%) per TESE or 32/72 (44.4%) per TESE with sperm retrieved.Of the female characteristics (couples with sperm available), only female age (30.3 vs 32.7 years; P = 0.042) was significantly lower in the group with a LB, compared to those without.The CLB with testicular sperm obtained after enzymatic digestion was 31.8% (14/44), while the CLB with sperm obtained after mincing alone was 64.3% (18/28). Multivariable logistic regression analysis showed that when enzymatic digestion was required, it was associated with a significant decrease in CLB per TESE (OR: 0.23 (0.08-0.7); P = 0.01). LIMITATIONS REASONS FOR CAUTION Limitations of the study are related to the retrospective design. However, the selection of only patients with NOA, and specific characteristics (normal karyotype and absence Y-q deletion) and having their first TESE, strengthens our findings. WIDER IMPLICATIONS OF THE FINDINGS Enzymatic processing increases the SR rate from testicular biopsies of NOA patients compared to mechanical mincing only, demonstrating the importance of an appropriate laboratory protocol. However, NOA patients should be counseled that when sperm have been found after enzymatic digestion, their chances to father a genetically own child may be lower compared to those not requiring enzymatic digestion. STUDY FUNDING/COMPETING INTERESTS None reported. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- V Vloeberghs
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - N De Munck
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Racca
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - I Mateizel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Wouters
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Utlu A, Ozkaya F, Aksakalli T, Cinislioglu AE, Demirdogen SO, Altay MS, Karabulut I, Ozbey I, Guclu Utlu S. Comparison of unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) in patients with non-obstructive azoospermia: a prospective study. Int Urol Nephrol 2023; 55:2177-2182. [PMID: 37330932 DOI: 10.1007/s11255-023-03668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To compare sperm retrieval rates between unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) procedures in patients with non-obstructive azoospermia and to contribute to the literature by comparing them with literature data. METHODS This prospective study included 84 males with primary infertility who had azoospermic NOA, who had been married for at least one year, and whose female partners did not have a history of infertility. The study was conducted between January 2019 and January 2020. MD-TESE was applied bilaterally to 48% (n:41) (Group 1) and unilaterally to 52% (n:43) (Group 2) of the patients, and sperm retrieval rates were compared. RESULTS There was no statistically significant difference between Group 1 patients and Group 2 patients in terms of sperm availability (61%, 56.5%, p=0.495, respectively). In addition, while no complications were observed in unilateral MD-TESEs, 3 complications were observed in bilateral MD-TESEs. CONCLUSIONS In our study, it was determined that there was no significant difference between the groups in terms of sperm availability in patients with NOA. Considering the operative time and complication rates of bilateral MD-TESE in patients diagnosed with NOA and the possible MD-TESE procedures that may be performed later, we believe that unilateral MD TESE is a more preferable procedure for the patient and surgeon in this patient group.
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Affiliation(s)
- Adem Utlu
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Fatih Ozkaya
- Department of Urology, Altınbas University, Bahcelievler Medicalpark Hospital, Istanbul, Turkey
| | - Tugay Aksakalli
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | | | | | - Ibrahim Karabulut
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Isa Ozbey
- Department of Urology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Sibel Guclu Utlu
- Emergency Medicine Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Bole R, Kaiyal RS, Lundy SD, Nguyen JK, Parekh N, Vij SC. Discordant Bilateral Testicular Pathology Does not Affect Sperm Retrieval Rate in Bilateral Microdissection Testicular Sperm Extraction (mTESE). Urology 2023; 176:82-86. [PMID: 37054923 DOI: 10.1016/j.urology.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/13/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To assess the incidence of discordant testicular pathology in men undergoing bilateral microdissection testicular sperm extraction (mTESE) and association with sperm retrieval rate. METHODS We performed a retrospective single-institutional review of all patients undergoing mTESE from 2007 to 2021 and aggregated clinical history, physical exam, semen analysis, and operative findings. Specimens with discordant pathology were re-reviewed by an experienced genitourinary.ßpathologist and categorized in a standardized fashion. Data were analyzed using SPSS. RESULTS One hundred fourteen non-obstructive azoospermia.ßmen undergoing 132 mTESEs were identified within the study period. Eighty-five percent (112/132) of cases had pathology specimens available, and within this specific cohort the success rate was 41.9% (47/112). A total of 206 pathological reports resulted including 52.4% Sertoli cell only, 4.9% Leydig cell hyperplasia, 8.7% fibrosis, 16.5% maturation arrest, and 17.5% hypospermatogenesis. Twelve percent of testicles had more than 1 pathologic diagnosis. Sixty-six men had synchronous bilateral testicular pathology, and 11/66 (16.6%) had at least partially discordant pathology on initial review. Focused re-review by a genitourinary pathologist confirmed exclusively discordant pathology in 7/66 (10.6%) cases, with a sperm retrieval rate of 57% (4/7). The sperm retrieval rate.ßin men with discordant pathology was not significantly different from those with concordant pathology. CONCLUSION Over 1 in 10 men undergoing mTESE may have discordant pathology between testicles, though this may not affect sperm retrieval rate.ßat the time of procedure. Clinicians should consider submitting bilateral testicular specimens for pathology to (1) clarify their outcomes data, and (2) assist with clinical decision-making and surgical planning if a repeat mTESE is indicated.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Raneen Sawaid Kaiyal
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Scott D Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Neel Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
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The Klinefelter Syndrome and Testicular Sperm Retrieval Outcomes. Genes (Basel) 2023; 14:genes14030647. [PMID: 36980920 PMCID: PMC10048758 DOI: 10.3390/genes14030647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Klinefelter syndrome (KS), caused by the presence of an extra X chromosome, is the most prevalent chromosomal sexual anomaly, with an estimated incidence of 1:500/1000 per male live birth (karyotype 47,XXY). High stature, tiny testicles, small penis, gynecomastia, feminine body proportions and hair, visceral obesity, and testicular failure are all symptoms of KS. Endocrine (osteoporosis, obesity, diabetes), musculoskeletal, cardiovascular, autoimmune disorders, cancer, neurocognitive disabilities, and infertility are also outcomes of KS. Causal theories are discussed in addition to hormonal characteristics and testicular histology. The retrieval of spermatozoa from the testicles for subsequent use in assisted reproduction treatments is discussed in the final sections. Despite testicular atrophy, reproductive treatments allow excellent results, with rates of 40–60% of spermatozoa recovery, 60% of clinical pregnancy, and 50% of newborns. This is followed by a review on the predictive factors for successful sperm retrieval. The risks of passing on the genetic defect to children are also discussed. Although the risk is low (0.63%) when compared to the general population (0.5–1%), patients should be informed about embryo selection through pre-implantation genetic testing (avoids clinical termination of pregnancy). Finally, readers are directed to a number of reviews where they can enhance their understanding of comprehensive diagnosis, clinical care, and fertility preservation.
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Herndon CC, Godart ES, Turek PJ. Testosterone levels among non-obstructive azoospermic patients 2 years after failed bilateral microdissection testicular sperm extraction: a nested case-cohort study. J Assist Reprod Genet 2022; 39:1297-1303. [PMID: 35469372 PMCID: PMC9174376 DOI: 10.1007/s10815-022-02497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To define the risk of hypogonadism following microdissection testicular sperm extraction in cases of non-obstructive azoospermia. While sperm retrieval by open testicular sperm extraction can be associated with an increased risk of hypogonadism, there is limited data addressing which procedures and which patients harbor the greatest risk. METHODS We report on a community-acquired, nested, case-cohort of non-obstructive azoospermic patients referred to one clinic after failed bilateral microdissection testicular sperm extraction. Patients were health-matched (1:2) to surgically naïve controls and divided into 2 cohorts based on risk factors for hypogonadism. Among microdissection patients, we compared total testosterone and gonadotropin levels before and > 6 months after surgery. Biochemical hypogonadism was defined as a total serum testosterone level ≤ 300 ng/dL. Hormone levels were compared to risk-matched controls. Comparative statistics were used to assess hormone levels within and between cohorts. RESULTS There were no significant differences in baseline testosterone levels between microdissection patients (n = 26) and risk-matched controls (n = 52). At a mean of 26 months (range 6.2-112.8) post-procedure, mean testosterone levels decreased significantly (73 ng/dL or 16%; CI - 27, - 166; p < 0.01, paired t-test). Among microdissection patients with baseline testosterone > 300 ng/dL, 8/22 (36%) experienced hypogonadism post-procedure. There was a corresponding increase in follicle stimulating hormone (p = 0.05) and a trending increase in luteinizing hormones (p = 0.10). CONCLUSION A durable decrease in testosterone levels occurs after failed microdissection testicular sperm extraction regardless of baseline risk of hypogonadism. In addition, a significant proportion of eugonadal patients will become hypogonadal after failed testicular microdissection procedures.
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Affiliation(s)
- Charles C Herndon
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Erica S Godart
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA
| | - Paul J Turek
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA.
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Tao Y. Oocyte Activation during Round Spermatid Injection: State of the Art. Reprod Biomed Online 2022; 45:211-218. [DOI: 10.1016/j.rbmo.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/06/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
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Inhibin-B and FSH Are Good Indicators of Spermatogenesis but Not the Best Indicators of Fertility. Life (Basel) 2022; 12:life12040511. [PMID: 35455002 PMCID: PMC9030543 DOI: 10.3390/life12040511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 01/19/2023] Open
Abstract
Biochemical markers of spermatogenesis and fertility assessment are important in the practical management of infertile males and the determination of an individual’s prognosis. We performed an analysis on 100 males with a male infertility factor. The following study inclusion parameters were analyzed: seminogram, FSH, LH, testosterone, estradiol, prolactin, TSH, and inhibin B concentrations. The patients were subsequently treated by reproductive endocrinologists in accordance with AUA/ASRM and EAU guidelines. The reproductive status was evaluated over a period of 3 years. We found a strong correlation of sperm count with inhibin B (r = 0.74, p < 0.001) and FSH concentration levels (r = −0.46, p < 0.001). Among 95 patients at follow-up, pregnancies occurred for 59 of their partners (48 spontaneous, 5 after IVF−ET, and 6 after IUI). Thirty-six patients remained childless despite the therapy. Sperm count and inhibin B level were the best predictors of natural fertilization (ROC AUC: 0.86 and 0.84; cut-off: 2.7 mln/mL and 45 pg/mL). Although inhibin B and FSH can be used to evaluate spermatogenesis and fertility, the initial sperm concentration appeared to be the best predictor of success. Pregnancy was achieved in a surprisingly large proportion of patients with a very low concentration of inhibin B and a low initial sperm count. It is noteworthy that 81% of the pregnancies were achieved without medically assisted reproduction.
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Ghalayini IF, Alazab R, Halalsheh O, Al-Mohtaseb AH, Al-Ghazo MA. Repeated microdissection testicular sperm extraction in patients with non-obstructive azoospermia: Outcome and predictive factors. Arab J Urol 2022; 20:137-143. [PMID: 35935909 PMCID: PMC9354641 DOI: 10.1080/2090598x.2022.2028066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the feasibility of repeated sperm recovery in patients with non-obstructive azoospermia (NOA), as little is known about the extraction rate in repeated microdissection testicular sperm extraction (microTESE) in these patients. Patients and Methods A total of 134 men with NOA had their first sperm recovery between January 2013 and February 2020. Repeated microTESE had been done mostly for patients with a successful initial retrieval. Results In the 323 procedures performed on the 134 men with NOA, sperm could be retrieved in 236 procedures (73.1%). A total of 88, 61 and 40 men underwent two, three and four sperm retrievals, respectively. In these cycles, sperm could be extracted in 65 (73.9%), 53 (86.9%) and 37 (92.5%) men, respectively. During the first microTESE procedure, sperm could be extracted in 81 (60.4%) men with NOA. In all, the success rate was significantly different between subgroups, showing highest rate in hypospermatogenesis cases (95.6%), followed by maturation arrest (58.5%), and Sertoli cell-only syndrome (56.0%). However, this difference was not significant at the third and fourth repeated microTESE. The FSH levels and testicular volume were among the noticeable factors affecting success of sperm retrieval. The duration between the first and second biopsies significantly increased the success rate by a factor of 1.3-fold/month; however, afterwards, the duration did not play any role in the success of microTESE. The success of previous trial significantly increased the probability of success by 10.1-fold in the second trial, 5.6-fold in the third trial, and 16.5 folds in the fourth. Conclusion Repeated MD -TESE ensures a high sperm recovery rate in patients with NOA. These data also show that when no spermatozoa can be obtained after thawing cryopreserved testicular sperm for ICSI in NOA patients, a repeat microTESE procedure can be planned. Abbreviations ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilisation; MA: maturation arrest; (N)OA: (non-)obstructive azoospermia; OR: odds ratio; SCOS, Sertoli cell-only syndrome; SRR: spermatozoa retrieval rate; (micro)TESE: (microdissection) testicular sperm extraction
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Affiliation(s)
- Ibrahim Fathi Ghalayini
- Urology Division, King Abdullah University Hospital/Jordan University of Science and Technology, Amman, Jordan
| | - Rami Alazab
- Urology Division, King Abdullah University Hospital/Jordan University of Science and Technology, Amman, Jordan
| | - Omar Halalsheh
- Urology Division, King Abdullah University Hospital/Jordan University of Science and Technology, Amman, Jordan
| | - Alia H. Al-Mohtaseb
- Pathology and Laboratory Department, King Abdullah University Hospital/Jordan University of Science and Technology, Amman, Jordan
| | - Mohammed A. Al-Ghazo
- Urology Division, King Abdullah University Hospital/Jordan University of Science and Technology, Amman, Jordan
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Özkan B, Coşkuner ER, Güdelci T. Predictive Factors and ICSI Results for Sperm Retrieval by Microdissection Testicular Sperm Extraction (micro-TESE) in Patients with Klinefelter Syndrome. Urology 2021; 161:59-64. [PMID: 34968572 DOI: 10.1016/j.urology.2021.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the predictive factors for successful retrieval of sperm from testicles before microdissection-testicular sperm extraction (micro-TESE) in patients with Klinefelter syndrome (KS) in order to counsel these patients regarding the likelihood of findings sperm. MATERIALS AND METHODS The study is a retrospective analysis of the records of 67 men with KS between April 2016 and August 2020. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, prolactin, and estradiol levels were investigated. Testicular volumes were measured by ultrasonography. TESE was noted as positive or negative. RESULTS There were 32 (47.8%) micro-TESE-negative patients and 35 (52.2%) m-TESE positive patients. The age of the micro-TESE-negative (34.9 ± 5.1 years) patient group was significantly higher than the micro-TESE-positive (32.3 ± 4.7 years) group (p = 0.035).The left testicular volume values were significantly higher in the micro-TESE-positive group (p = 0.019). FSH, LH, and prolactin levels were higher in m-TESE-negative patients compared to micro-TESE-positive patients, and testosterone levels and testicular volume were lower in micro-TESE-negative patients compared to micro-TESE-positive patients. However, these differences were not significant. As a result of intracytoplasmic sperm injection (ICSI) performed on 31 couples, 20 pregnancies and 16 live births were obtained (51.06%). CONCLUSION Among the parameters examined in this study, the age of the patient with KS may be predictive for micro-TESE success. Counseling should be given that some patients with KS may have a child via micro-TESE-ICSI.
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Affiliation(s)
- Burak Özkan
- Department of Urology, Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
| | - Enis Rauf Coşkuner
- Department of Urology, Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Tansu Güdelci
- Department of Urology, Acibadem Maslak Hospital, Istanbul, Turkey
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Amer M, Fakhry E. Fresh vs frozen testicular sperm for assisted reproductive technology in patients with non-obstructive azoospermia: A systematic review. Arab J Urol 2021; 19:247-254. [PMID: 34552776 PMCID: PMC8451649 DOI: 10.1080/2090598x.2021.1932303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective : To review the debate about the routine use of cryopreserved testicular sperm for intracytoplasmic sperm injection (ICSI) from patients with non-obstructive azoospermia (NOA), as some authors suggest repeating sperm retrieval in such cases due to poorer ICSI results when frozen–thawed testicular sperm is used compared with fresh sperm. Methods : A systematic literature review was performed in August 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science databases and the Excerpta Medica dataBASE (EMBASE), and we included 26 studies that were considered eligible for this systematic review. Results : In all, 1189 publications were screened and 26 articles were included in the systematic review. Three meta-analysis reviews were included and they all concluded that the use of fresh and frozen sperms for ICSI from patients with NOA showed comparable fertilisation and pregnancy rates. Conclusion : The use of frozen testicular sperm from men with NOA results in fertilisation and clinical pregnancy rates similar to those of fresh sperm. This may encourage fertility centres to use frozen testicular sperm samples, as this policy has certain advantages that would help with organising their workflow. Abbreviations: CPR: clinical pregnancy rate; 2PN%: two pronuclei % fertilisation rate; ICSI: intracytoplasmic sperm injection; NOA: non-obstructive azoospermia; OA, obstructive azoospermia; SCO: Sertoli cell-only syndrome; (micro-)TESE: (microsurgical) testicular sperm extraction
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Affiliation(s)
- Medhat Amer
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt.,Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Fakhry
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt
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Aboukhshaba A, Punjani N, Doukakis S, Schlegel PN. Anti-Müllerian hormone level as a predictor of sperm retrieval with microdissection testicular sperm extraction in nonobstructive azoospermia. Andrologia 2021; 53:e14220. [PMID: 34423455 DOI: 10.1111/and.14220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022] Open
Abstract
Limited factors effectively predict sperm retrieval with microdissection testicular sperm extraction in men with nonobstructive azoospermia. We therefore sought to evaluate the role of serum anti-Müllerian hormone as a predictive biomarker for successful sperm retrieval. We included patients with pre-operative anti-Müllerian hormone levels and stratified them based on prior history of prior sperm retrieval procedure. We compared hormone levels between those who did and did not have a successful sperm retrieval and used receiver operating curves to determine an optimal cut-off value. A total of 46 men were included, of whom 18 (39.1%) had no prior sperm retrieval and 11 (61.1%) had sperm successfully retrieved. Pre-operative serum anti-Müllerian hormone levels were predictive of sperm retrieval in patients with no prior attempts at retrieval (p = .03). Receiver operating curve for those without prior retrieval was 0.6753. The optimal anti-Müllerian hormone cut-off for those without prior sperm retrieval was 0.133 ng/ml with a sensitivity of 0.91 and specificity of 0.29. Therefore, serum anti-Müllerian hormone levels have modest predictive value for sperm retrieval in this cohort. The combination of clinical history, examination and laboratory investigations should continue to be used to guide surgeons in counselling patients regarding the chance of sperm retrieval.
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Affiliation(s)
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Sofia Doukakis
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
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Spahovic H, Alic J, Göktolga Ü, Lepara Z, Lepara O, Rama A, Suljevic I. "Second-look" Micro Testicular Sperm Extraction (MicroTESE) in Patients with Non-obstructive Azoospermia Following Histopathological Analysis. Med Arch 2021; 74:279-284. [PMID: 33041445 PMCID: PMC7520053 DOI: 10.5455/medarh.2020.74.279-284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). Aim: This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the „second-look“ procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population. Methods: The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient’s history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for „second-look“ microTESE attempt. Results: Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a „second-look“ procedure after the evaluation of histopathological reports. After the stimulation therapy and „second-look“ procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038). Conclusion: Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the „second-look“ microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the “second-look” procedure.
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Affiliation(s)
- Hajrudin Spahovic
- Urology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jasmin Alic
- Urology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ümit Göktolga
- Bahçeci BIH IVF Center, Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zahid Lepara
- Urology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Orhan Lepara
- Department of Physiology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Admir Rama
- Bahçeci BIH IVF Center, Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ismet Suljevic
- Clinic for Anesthesia and Resuscitation, Clinical Center Sarajevo, Bosnia and Herzegovina
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Billa E, Kanakis GA, Goulis DG. Endocrine Follow-Up of Men with Non-Obstructive Azoospermia Following Testicular Sperm Extraction. J Clin Med 2021; 10:jcm10153323. [PMID: 34362107 PMCID: PMC8347935 DOI: 10.3390/jcm10153323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Testicular sperm extraction (TESE) is a surgical procedure which, combined with intracytoplasmic sperm injection, constitutes the main treatment for achieving biological parenthood for patients with infertility due to non-obstructive azoospermia (NOA). Although it is effective, TESE procedures might cause structural testicular damage leading to Leydig cell dysfunction and, consequently, temporary or even permanent hypogonadism with long-term health consequences. To a lesser extent, the same complications have been reported for microdissection TESE, which is considered less invasive. The resulting hypogonadism is more profound and of longer duration in patients with Klinefelter syndrome compared with other NOA causes. Most studies on serum follicle-stimulating hormone and luteinizing hormone concentrations negatively correlate with total testosterone concentrations, which depends on the underlying histology. As hypogonadism is usually temporary, and a watchful waiting approach for about 12 months postoperative is suggested. In cases where replacement therapy with testosterone is indicated, temporary discontinuation of treatment may promote the expected recovery of testosterone secretion and revise the decision for long-term treatment.
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Affiliation(s)
- Evangelia Billa
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
- Correspondence: (E.B.); (G.A.K.)
| | - George A. Kanakis
- IVF Unit, Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, 11521 Athens, Greece
- Correspondence: (E.B.); (G.A.K.)
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
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A cryoprotectant supplemented with pentoxifylline can improve the effect of freezing on the motility of human testicular sperm. ZYGOTE 2021; 30:92-97. [PMID: 34158133 DOI: 10.1017/s0967199421000368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined the effect of a cryoprotectant with and without pentoxifylline supplementation on the motility and viability of human testicular sperm, both before and after freezing. Testicular samples were obtained from 68 patients with azoospermia who came to the Andrology Service of West China Second University Hospital, Sichuan University, for testicular biopsies from December 2019 to April 2020. All patients were assigned randomly to two groups: experimental, whose testicular sperm were added to the cryoprotectant with pentoxifylline, and the control, whose testicular sperm were added to the cryoprotectant without pentoxifylline. Both groups used the same freezing and thawing methods. Testicular sperm motility in the experimental group was significantly higher than that of the control group, both before and after cryopreservation. The recovery rate of sperm motility in the experimental group was significantly higher than that of the control group. The percentage of samples with motile testicular sperm in the experimental group was significantly higher than that of the control group after thawing. Sperm viability was unchanged between the experimental and control groups, both before and after freezing. Overall, a pentoxifylline-supplemented cryoprotectant can significantly improve the motility of testicular sperm before and after cryopreservation.
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SHARMA HIMANSHU, SHARMA UJJAWAL, KUMAR SANTOSH, SINGH SHRAWANKUMAR, MAVADURU RAVIMOHANS, PRASAD RAJENDRA. Prevalence of Y chromosome microdeletion in north Indian infertile males with spermatogenesis defect. J Genet 2021. [DOI: 10.1007/s12041-021-01291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Galea LA, Sturrock S, Appu S, Katz DJ. Improving interpretation of biopsies during microsurgical testicular sperm exploration in azospermic patients: use of Davidson's fluid. Pathology 2021; 53:735-739. [PMID: 33947524 DOI: 10.1016/j.pathol.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
Histological interpretation of testicular biopsies in the investigation of infertility in men with azoospermia requires adequate tissue fixation to preserve the nuclear and cytoplasmic detail, as well as the architectural organisation of germ cells in different phases of maturation within seminiferous tubules. The aim of the study was to assess the histomorphological quality of testicular biopsies using Davidson's fluid (DF) as fixative and compare it to standard 10% neutral buffered formalin. Concurrent testicular biopsies from the same testis from patients undergoing microsurgical testicular sperm exploration (m-TESE) were separately fixed in DF and formalin and processed for histological examination. Histological parameters including sloughing of cells, cytoplasmic shrinkage of seminiferous tubular cells, nuclear chromatin detail, cytoplasmic graininess and overall clarity of morphological detail were graded on a scale of 0-4 (0, none; 1, minimal; 2, slight; 3, moderate; 4, marked). The effect of DF on biopsy diagnoses was assessed by comparison with corresponding formalin fixed biopsy diagnoses. Eighty-seven testicular biopsies from 27 patients were examined. DF fixation resulted in significantly less luminal sloughing of cells (1.59±1.34 vs 3.44±0.83, p≤0.00001), less cytoplasmic shrinkage of seminiferous tubular cells (1.58±1.11 vs 3.11±1.07, p≤0.00001), better nuclear chromatin detail (3.06±0.91 vs 1.92±0.48, p≤0.00001), less cytoplasmic graininess (2.11±0.96 vs 2.86±0.87, p=0.0014) and better overall clarity of morphological detail than formalin fixation (3.14±0.69 vs 2.14±0.58, p≤0.00001). The diagnostic concordance between DF fixed and formalin fixed biopsies was 90.8%. This study supports the use of DF as a superior alternative fixative to formalin for histological assessment of testicular biopsies.
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Affiliation(s)
- Laurence A Galea
- Department of Histopathology, Melbourne Pathology, Melbourne, Vic, Australia.
| | - Sue Sturrock
- Department of Histopathology, Melbourne Pathology, Melbourne, Vic, Australia
| | - Sree Appu
- Department of Surgery, Monash University, Melbourne, Vic, Australia
| | - Darren J Katz
- Men's Health Melbourne, Melbourne, Vic, Australia; Department of Surgery, Western Precinct, University of Melbourne, Vic, Australia; Department of Urology, Western Health, Melbourne, Vic, Australia
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17
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Punjani N, Kang C, Schlegel PN. Two Decades from the Introduction of Microdissection Testicular Sperm Extraction: How This Surgical Technique Has Improved the Management of NOA. J Clin Med 2021; 10:jcm10071374. [PMID: 33805395 PMCID: PMC8037781 DOI: 10.3390/jcm10071374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/19/2023] Open
Abstract
The treatment of men with non-obstructive azoospermia (NOA) has improved greatly over the past two decades. This is in part due to the discovery of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), but also significantly due to improvements in surgical sperm retrieval methods, namely the development of microdissection testicular sperm extraction (mTESE). This procedure has revolutionized the field by allowing for identification of favorable seminiferous tubules while simultaneously limiting the amount of testicular tissue removed. Improving sperm retrieval rates is imperative in this cohort of infertile men as there are a limited number of factors that are predictive of successful sperm retrieval. Currently, sperm retrieval in NOA men remains dependent on surgeon experience, preoperative patient optimization and teamwork with laboratory personnel. In this review, we discuss the evolution of surgical sperm retrieval methods, review predictors of sperm retrieval success, compare and contrast the data of conventional versus mTESE, share tips for optimizing sperm retrieval outcomes, and discuss the future of sperm retrieval in men with NOA.
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18
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Rohan P, Daly N, O'Kelly A, O'Leary M, Dineen T, Shah N, Daly P, Waterstone J, Cullen I. Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia. J Reprod Infertil 2021; 22:103-109. [PMID: 34041006 PMCID: PMC8143015 DOI: 10.18502/jri.v22i2.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Microdissection testicular sperm extraction (mTESE) is the gold standard approach in sperm retrieval in men with non-obstructive azoospermia (NOA). The purpose of the study was to assess the outcomes for Irish men who have undergone mTESE with a single surgeon. Methods This is a retrospective, single cohort study. Thirty-four patients underwent mTESE between September 2015 and June 2019. A p<0.05 was considered statistically significant. Results In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10-5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle. Conclusion The combination of mTESE/Intracytoplasmic sperm injection (ICSI) is the best option available for men with NOA who prefer to achieve paternity using their own DNA. Given the overall SRRs in mTESE, it is imperative to continue research for a predictive model to better counsel azoospermic men regarding the use of mTESE. For this purpose, large, multicenter, randomized controlled trials are needed.
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Affiliation(s)
- Pat Rohan
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | | | - Aoife O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Martin O'Leary
- College of Science, University College Dublin, Dublin, Ireland
| | | | - Nigam Shah
- Department of Pathology, University Hospital Waterford, Waterford, Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | | | - Ivor Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland
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Kailash Y, Raheem AA, Homa ST. How Successful Is Surgical Sperm Retrieval in Klinefelter Syndrome? FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:636629. [DOI: 10.3389/frph.2021.636629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). This review article summarizes the success rates of the available techniques for surgical sperm retrieval (SSR) in KS including conventional testicular sperm extraction (cTESE) and micro testicular sperm extraction (mTESE), as well as the risks of these procedures for future fertility. The evidence indicates that the SSR rate is as successful in non-mosaic men with KS as those with normal karyotypes, with retrieval rates of up to 55% reported. The influence of different factors that affect the chances of a successful outcome are discussed. In particular, the impact of aneuploidy rate, physical characteristics, co-morbidities, reproductive endocrine balance and the use of different hormone management therapies are highlighted. Evidence is presented to suggest that the single most significant determinant for successful SSR is the age of the patient. The success of SSR is also influenced by surgical technique and operative time, as well as the skills of the surgeon and embryology team. Rescue mTESE may be used successfully following failed TESE in KS patients in combination with hormone stimulation.
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20
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Muncey W, Dutta R, Terlecki RP, Woo LL, Scarberry K. Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports. Andrology 2021; 9:781-791. [PMID: 33354918 DOI: 10.1111/andr.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT. METHODS A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult" AND "bilateral orchidopexy" OR "bilateral cryptorchidism." Relevant referenced articles from non-indexed journal were identified by Google Scholar search and additionally included. RESULTS Fifty-seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3). CONCLUSION Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.
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Affiliation(s)
- Wade Muncey
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rahul Dutta
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Lynn L Woo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Kyle Scarberry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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21
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Norioun H, Motovali-Bashi M, Javadirad SM. Hsa-miR-27a-3p overexpression in men with nonobstructive azoospermia: A case-control study. Int J Reprod Biomed 2020; 18:961-968. [PMID: 33349804 PMCID: PMC7749971 DOI: 10.18502/ijrm.v13i11.7963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/04/2019] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background The role of KDM3A and its downstream genes in male fertility has been approved in animal models. Additionally, the expression shrinkage of KDM3A is significantly correlated with human azoospermia phenotype. Aberrant expression of micro-RNAs could mislead spermatogenesis and mostly lead to diverse phenotypes of male infertility. Objective The aim of this study was to evaluate the expression level of hsa-miR-27a-3p in azoospermic men to reveal its possible association with infertility. Materials and Methods This case-control study was conducted on 30 azoospermic men, of whom, 19 had non obstructive azoospermia (NOA) and 11 obstructive azoospermia (OA) according to the pathological examinations. Comprehensive bioinformatics investigations were performed securely and hsa-miR-27a-3p was selected afterward. Reverse Transcriptase-quantitative polymerase chain reaction (RT-qPCR) method was used and statistical analysis was performed to compare the expression level of hsa-miR-27a-3p in both OA and NOA individuals. Results In silico analysis suggested hsa-miR-27a-3p, with its potential binding ability to target KDM3A transcripts. The expression analysis of candidate hsa-miR-27a-3p indicated its significant overexpression in NOA men. Conclusion The hsa-miR-27a-3p was overexpressed in NOA men compared to OA-control individuals. As a consequence, the overexpressed micro-RNA could downregulate directly KDM3A and indirectly TNP1 and PRM1. Therefore, spermatogenesis could be misled and male infertility could be developed.
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Affiliation(s)
- Hamid Norioun
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Majid Motovali-Bashi
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Seyed Morteza Javadirad
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
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22
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Liu YP, Qi L, Zhang NN, Shi H, Su YC. Follicle-stimulating hormone may predict sperm retrieval rate and guide surgical approach in patients with non-obstructive azoospermia. Reprod Biol 2020; 20:573-579. [PMID: 33203587 DOI: 10.1016/j.repbio.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/14/2020] [Accepted: 10/17/2020] [Indexed: 02/06/2023]
Abstract
Testicular sperm aspiration- (TESA) or micro-dissection testicular sperm extraction- (MD-TESE) combined intracytoplasmic sperm injection (ICSI) was the only option for non-obstructive azoospermia (NOA) patients to have a biological offspring and they had different success rates in sperm retrieval. Our study aimed to find predictor(s) for predicting the sperm retrieval rate (SRR) in NOAs and guide clinicians in choosing different surgical approaches, TESA or MD-TESE for NOAs. 294 NOAs who had undergone TESA or MD-TESE were divided into TESA group and MD-TESE group. Depending on sperm retrieval, each group was divided into two subgroups: successful subgroups and failure subgroups. They respectively were 24 cases and 131 cases, 53 cases and 86 cases. Clinical data, including body mass index (BMI), testicular volume, and serum hormone levels, were analyzed in a retrospective manner. The results showed that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and SRR were lower in TESA group as compared to these in MD-TESE group, while testicular volume was higher (P < 0.05). The surgical approach of sperm retrieval significantly affected the SRR (P < 0.05). In TESA subgroups, testicular volume, FSH and LH differed significantly (P < 0.05). In MD-TESE subgroups, the level of FSH and LH differed significantly between both groups (P < 0.05). Using logistics regression, we found a negative correlation (β=-0.083) between FSH and the SRR in TESA group but a positive correlation (β = 0.064) in MD-TESE group (P < 0.05). In conclusion, serum FSH level can predict the SRR of NOAs and guide the clinicians while selecting the suitable surgery approach for NOAs.
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Affiliation(s)
- Ya-Ping Liu
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Lin Qi
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Nan-Nan Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hao Shi
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Ying-Chun Su
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China.
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Abstract
Along with the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures now allow the possibility of conception from male sterility. In cases of sterility due to blockages in the reproductive tract, sperm retrieval procedures are relatively straightforward and reliable. In nonobstructive azoospermia or testis failure, sperm often can be difficult to retrieve. For this reason, the field of testicular sperm retrieval has witnessed tremendous change and innovation to achieve higher sperm yields, increasing efficiency and safety, along with fewer complications. We review the history and evolution of testicular sperm retrieval since its inception. Using the findings from randomized controlled trials, basic science studies, meta-analyses, case-controlled or cohort studies, best-practice policies, and literature reviews, we outline the concepts, facts, and principles that have been elucidated over several decades of experience with sperm retrieval. We also appraise the merits and issues of the most popular sperm retrieval techniques and strategies. Finally, we define areas of future clinical and laboratory development that will further refine the field of testicular sperm retrieval.
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Affiliation(s)
- Erica S Godart
- The Turek Clinic, 55 Francisco Street, Suite 705, San Francisco, CA 94133, USA
| | - Paul J Turek
- The Turek Clinic, 55 Francisco Street, Suite 705, San Francisco, CA 94133, USA
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Zambrano Serrano C, Carvajal Obando A. Surgical treatment for male infertility. Actas Urol Esp 2020; 44:314-320. [PMID: 32147350 DOI: 10.1016/j.acuro.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Abstract
Given the nature of the multiple causes of male infertility, some of them are «reversible» and can be managed with a surgical procedure to recover, in some cases, the fertilizing capacity of the male reproductive tract. With appropriate use of diagnostic tools and clinical judgement, the physician can identify the ideal candidates for these procedures. Together with the expertise and experience of the surgeon, these treatments can manage to resolve the barrier, and men may become fertile again. In this chapter, we will review some of the most commonly used surgical procedures for the treatment of male infertility and make a brief description of their technical details.
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Pavan-Jukic D, Starc A, Stubljar D, Jukic T. Obesity with High Body Mass Index Does Not Influence Sperm Retrieval in Males with Azoospermia. Med Sci Monit 2020; 26:e923060. [PMID: 32472670 PMCID: PMC7282346 DOI: 10.12659/msm.923060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the influence of male body mass index (BMI) on the retrieval of sperm from azoospermic patients who were undergoing testicular sperm extraction (TESE). MATERIAL AND METHODS The study included retrospective data of male patients suffering from non-obstructive azoospermia (NOA). Age, BMI, testicular volumes, the serum concentration of the follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and prolactin were investigated and collected. RESULTS A total of 75 azoospermic males were evaluated between 2014 and 2019, including 35 patients (46.7%) with positive sperm retrieval. The majority of patients (57.3%) had normal BMI (between 20 kg/m² and 25 kg/m²) or first degree obesity (from 25 kg/m² to 30 kg/m²). No statistically significant correlation between BMI and positive sperm retrieval or hormone levels (LH, FSH, SHBG, prolactin) were found. However, lower serum testosterone levels were observed in patients with higher BMI (P=0.035). Receiver operating characteristic curve analysis showed that none of the hormones could potentially predict the positive outcome of TESE. CONCLUSIONS The hormonal levels or patient's BMI could not predict positive sperm retrieval outcome, however a negative correlation between serum testosterone and BMI levels was calculated implicating influence on fertility.
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Affiliation(s)
- Doroteja Pavan-Jukic
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Andrej Starc
- Chair of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - David Stubljar
- Department of Research and Development, In-Medico, Metlika, Slovenia
| | - Tomislav Jukic
- Department of Internal Medicine, History of Medicine and Medical Ethics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Amer MK, Ahmed HEH, GamalEl Din SF, Fawzy Megawer A, Ahmed AR. Evaluation of neoadjuvant gonadotropin administration with downregulation by testosterone prior to second time microsurgical testicular sperm extraction: A prospective case-control study. Urologia 2020; 87:185-190. [PMID: 32323641 DOI: 10.1177/0391560320913401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this prospective study was to determine whether there is a beneficial role of combining gonadotropin administration with testosterone downregulation in non-obstructive azoospermia patients prior to a second time microsurgical testicular sperm extraction after a negative one. METHODS A total of 40 non-obstructive azoospermia men were recruited from a specialized IVF center from 2014 to 2016. Participants were divided equally into two groups: Group A was subjected to testosterone downregulation alone for 1 month and then combined with gonadotropin administration for 3 months prior to second time testicular sperm extraction; Group B (controls) underwent second time microsurgical testicular sperm extraction without prior hormonal therapy. RESULTS Mean baseline follicle-stimulating hormone levels of the controls and the cases were 26.9 ± 11.8 and 25.4 ± 8.7, respectively. One month after testosterone downregulation, follicle-stimulating hormone level of the cases was normalized and became 2.4 ± 1.2. There was no statistically significant difference between baseline follicle-stimulating hormone levels of the controls and cases (p = 0.946). Remarkably, two cases were positive after downregulation (10%) and no controls were positive at second testicular sperm extraction (0%). There was no statistically significant difference between sperm retrieval after the second microsurgical testicular sperm extraction in the controls and the cases (p = 0.072). CONCLUSION Patients who underwent first time testicular sperm extraction with unfavorable outcome due to different techniques may benefit from testosterone downregulation combined with neoadjuvant gonadotropin administration as it had shown positive sperms retrieval in 2 out of the 20 cases, especially those with hypergonadotropic azoospermia.
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Affiliation(s)
- Medhat Kamel Amer
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Adam International Hospital, Giza, Egypt
| | - Hossam ElDin Hosni Ahmed
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Adam International Hospital, Giza, Egypt
| | - Sameh Fayek GamalEl Din
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Fawzy Megawer
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ragab Ahmed
- Andrology and STDs Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Jahromi BN, Zeyghami S, Parsanezhad ME, Ghaemmaghami P, Zarei A, Kutenaee MA, Sohail P, Keshavarz P. Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:165-170. [PMID: 32236315 PMCID: PMC10118940 DOI: 10.20945/2359-3997000000217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/03/2019] [Indexed: 11/23/2022]
Abstract
Objective To determine the optimal cut-off value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cut-off value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cut-off value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Department of OB-GYN, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahryar Zeyghami
- Ghadir madar Hospital, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ebrahim Parsanezhad
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvin Ghaemmaghami
- Departments of biostatistics, medical school, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsoon Zarei
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Azizi Kutenaee
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parastoo Sohail
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Vieira M, Glina FPA, Mizrahi FE, Mierzwa TC, Glina S. Open testicular mapping: A less invasive multiple biopsy approach for testicular sperm extraction. Andrologia 2020; 52:e13547. [PMID: 32101335 DOI: 10.1111/and.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/16/2020] [Accepted: 02/02/2020] [Indexed: 10/24/2022] Open
Abstract
This study proposes a testicular sperm extraction technique that was inspired by testicular fine-needle aspiration. Here, we have described the technique of open testicular mapping (OTEM) and evaluated the successful sperm recovery in 92 patients with nonobstructive azoospermia (NOA). All patients underwent an OTEM biopsy. Patients were divided into two groups; group I included men with spermatozoa recovered and group 0 included men without spermatozoa recovered. Age, follicle-stimulating hormone (FSH) level and testicular volume were compared between the groups. In 50 of 92 men (54%), viable spermatozoa were found after OTEM. No differences were noted in age, FSH level or testicular volume. Using OTEM, it was possible to retrieve spermatozoa in 54% of the NOA men.
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Affiliation(s)
| | | | | | | | - Sidney Glina
- Urology Department, ALFA Clinic, São Paulo, Brazil
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Das A, Halpern JA, Darves-Bornoz AL, Patel M, Wren J, Keeter MK, Brannigan RE. Sperm retrieval success and testicular histopathology in idiopathic nonobstructive azoospermia. Asian J Androl 2020; 22:555-559. [PMID: 32341211 PMCID: PMC7705975 DOI: 10.4103/aja.aja_137_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Prior studies have investigated sperm retrieval rates in men with nonobstructive azoospermia (NOA) secondary to specific etiologies, yet most cases of NOA are idiopathic. We compared sperm retrieval rates and testicular histopathology in idiopathic NOA (iNOA) and nonidiopathic NOA (niNOA). We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic. Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology. Among 224 men, 86 (38.4%) were idiopathic, 75 (33.5%) were nonidiopathic, and 63 (28.1%) did not undergo genetic testing. Median age and serum testosterone were higher among iNOA or no testing versus niNOA. Median follicle-stimulating hormone (FSH) was lower among iNOA or no testing versus niNOA. A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele. Sperm retrieval rates were similar between iNOA, niNOA, and no testing (41.8% vs 48.0% vs 55.6%, respectively; P = 0.255). Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA (31.4% and 27.0% vs 16.0%, P = 0.073). On multivariable analysis, iNOA was not associated with sperm retrieval or spermatogenesis (P = 0.430 and P = 0.078, respectively). Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA. These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.
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Affiliation(s)
- Arighno Das
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Annie L Darves-Bornoz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mehul Patel
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - James Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Pavan-Jukic D, Stubljar D, Jukic T, Starc A. Predictive factors for sperm retrieval from males with azoospermia who are eligible for testicular sperm extraction (TESE). Syst Biol Reprod Med 2019; 66:70-75. [DOI: 10.1080/19396368.2019.1680764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Doroteja Pavan-Jukic
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - David Stubljar
- Department of Research & Development, In-Medico, Metlika, Slovenia
| | - Tomislav Jukic
- Department of Internal Medicine, History of Medicine and Medical Ethics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Andrej Starc
- Faculty of Health Sciences, University of Ljubljana, Chair of Public Health, Ljubljana, Slovenia
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Taitson PF, Mourthé A, Radaelli MRM. Testicular sperm extraction in men with sertoli cell-only testicular histology - 1680 cases. JBRA Assist Reprod 2019; 23:246-249. [PMID: 30969740 PMCID: PMC6724385 DOI: 10.5935/1518-0557.20190023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To study the outcomes of testicular sperm extraction (TESE) among men with
pure Sertoli cell-only histology identified during diagnostic testicular
biopsy. Methods: This retrospective cohort study involved 1680 cases of patients with
nonobstructive azoospermia (NOA) diagnosed with pure Sertoli cell-only
histology who underwent testicular biopsy with TESE in a reference center in
Brazil by a single surgeon. Sperm retrieval rates (SSR) were the main
outcome measure. Results: Overall, 14.83% of patients with Sertoli cell-only had sperm retrieved with
TESE in quantity that allowed the performance of ICSI. No differences were
observed in SSR based on testis volume (<15 mL vs.
<15 mL) or serum FSH level. Conclusions: Patients with Sertoli cell-only histology can be counseled that they have
some likelihood of sperm retrieval with TESE. Based on the findings,
patients to be submitted to testicular biopsy for histologic analysis may be
concomitantly prepared for ICSI with TESE in case sperm is available.
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Affiliation(s)
- Paulo Franco Taitson
- Human Reproduction Discipline, DCB/ICBS, Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte, MG, Brazil
| | - Antônio Mourthé
- ICBS, Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte, MG, Brazil
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A Novel Dual Immunostain to Characterize Sloughed Cells in Testicular Biopsies for Infertility. Am J Surg Pathol 2019; 43:1123-1128. [DOI: 10.1097/pas.0000000000001281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salama R, Al-Obaidy KI, Perrino CM, Grignon DJ, Ulbright TM, Idrees MT. DOG1 immunohistochemical staining of testicular biopsies is a reliable tool for objective assessment of infertility. Ann Diagn Pathol 2019; 40:18-22. [PMID: 30849695 DOI: 10.1016/j.anndiagpath.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
Testicular biopsy may be a component of the work-up of male infertility. However, no reliable diagnostic tools are available for objective quantitative assessment of spermatogenic cells. It is well known that MAGE-A4 is selectively expressed in spermatogonia and our group has previously demonstrated that DOG1 differentially stains germ cells. Therefore, we performed DOG1 and a double stain cocktail (DOG1 and 57b murine monoclonal anti-MAGE-A4) immunohistochemical stains on 40 testicular infertility biopsies (10 each with active spermatogenesis, Sertoli cell-only, hypospermatogenesis, and maturation arrest), 25 benign seminiferous tubules from radical orchiectomies, and 5 spermatocytic tumors (ST). In biopsies/resections with active spermatogenesis, DOG1 stained spermatocytes and spermatids and was absent in spermatogonia, while MAGE-A4 stained spermatogonia and primary spermatocytes (weak). In hypospermatogenesis, DOG1 highlighted decreased spermatocytes/spermatids and MAGE-A4 highlighted decreased spermatogonia. DOG1 staining confirmed decreased to absent spermatocytes in maturation arrest and MAGE-A4 staining established the presence of preserved spermatogonia in all cases. All STs were negative for DOG1 and positive for MAGE-A4, while all Sertoli cell-only cases were negative for DOG1 and the double stain cocktail. In conclusion, we confirmed that DOG1 is expressed in spermatocytes and spermatids and MAGE-A4 highlights primarily spermatogonia. Usage of these stains facilitates confirmation of maturation arrest, assessment of the percentage of testis involvement in hypospermatogenesis and identification of mixed patterns. Finally, this study supports that the differentiation of STs is more closely related to spermatogonia than the more mature spermatocytes.
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Affiliation(s)
- Rasha Salama
- Department of Pathology, St. Elizabeth Healthcare, Edgewood, KY, USA
| | - Khaleel I Al-Obaidy
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - David J Grignon
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas M Ulbright
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad T Idrees
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Shrem G, Brudner Y, Atzmon Y, Michaeli M, Ellenbogen A, Shalom-Paz E. The influence of obesity, smoking, and serum follicular stimulating hormone in azoospermic patients on testicular sperm extraction-intra cytoplasmic sperm injection outcomes: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14048. [PMID: 30681561 PMCID: PMC6358354 DOI: 10.1097/md.0000000000014048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To examine the effect of serum follicle-stimulating hormone (sFSH) level, body-mass index (BMI) and smoking on Testicular Sperm Extraction-Intracytoplasmic Sperm Injection (TESE-ICSI), and pregnancy outcomes.In this retrospective study, data were extracted from files of 52 azoospermic men who underwent TESE and in-vitro fertilization (IVF)-ICSI in our IVF unit. Demographic information, treatment cycle follow-up and pregnancy outcomes were collected.Fifty-two patients underwent 79 TESE due to azoospermia in 143 IVF cycles. Smoking was found to significantly affect sperm motility in TESE specimens before freezing (45.5% vs 14.8%; P <.001); however, this finding did not influence the pregnancy rate. Male FSH was inversely correlated with testicle volume (r = -0.595, P <.0001). Body weight did not affect semen parameters after TESE or ICSI outcomes.Among azoospermic patients with extremely poor sperm quality, male BMI, male FSH or smoking did not have an adverse effect sperm parameters or pregnancy and delivery rates.
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Affiliation(s)
- Guy Shrem
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yana Brudner
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yuval Atzmon
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Mediea Michaeli
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Adrian Ellenbogen
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
| | - Einat Shalom-Paz
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
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Cito G, Coccia ME, Picone R, Nesi G, Cocci A, Dabizzi S, Garaffa G, Fucci R, Falcone P, Bertocci F, Santi R, Criscuoli L, Serni S, Carini M, Natali A. Novel method of histopathological analysis after testicular sperm extraction in patients with nonobstructive and obstructive azoospermia. Clin Exp Reprod Med 2018; 45:170-176. [PMID: 30538947 PMCID: PMC6277673 DOI: 10.5653/cerm.2018.45.4.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022] Open
Abstract
Objective To assess whether the “testicular pool” could be used for histological analysis and whether it gave more accurate information than the standard testicular biopsy. Methods Between January 2017 and March 2018, this single-center prospective study included 60 azoospermic men undergoing conventional bilateral testicular sperm extraction. Six samples were excised from each testicle and transferred to an embryologist. One additional biopsy was randomly taken from each testis for a histological analysis. After processing, the testicular pool was also sent for a histological analysis, which showed normal spermatogenesis (NS), hypospermatogenesis (HYPO), maturation arrest (MA), Sertoli cell-only syndrome (SCOS), and tubular atrophy (TA). Results Twenty of the 60 patients (33.3%) had obstructive azoospermia (OA), while the remaining 40 (66.6%) had nonobstructive azoospermia. Their mean age was 40.5 years. All patients with OA had previously undergone unsuccessful testicular fine-needle aspiration. Successful sperm retrieval (SSR) occurred in 93.3% of patients. Histological analysis of the testicular biopsy revealed NS in 12 patients (20%), HYPO and TA in 28 patients (46.6%), MA in eight patients (13.3%), and SCOS in 12 patients (20%). The testicular pool analysis showed NS in 12 patients (20%), HYPO and TA in 44 patients (73.3%), MA in four patients (6.6%), and SCOS in no patients. In four patients with MA (6.6% of the total sample) and 12 patients with SCOS (20% of the total sample) according to the standard testicular biopsy, the embryologist found SSR with cryopreservation. Overall, in 44 patients (73.3%), the testicular pool analysis confirmed the histological findings of the standard testicular biopsy. In the 16 cases (26.6%) with a discrepancy between the single-biopsy histological findings and SSR, the testicular pool analysis confirmed the embryological data on SSR. Conclusion The testicular pool proved to be easily analyzable, practical, manageable, and more accurate for predicting sperm retrieval than standard testicular biopsy.
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Affiliation(s)
- Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria Elisabetta Coccia
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Gabriella Nesi
- Department of Pathology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sara Dabizzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi Hospital, University of Florence, Florence, Italy
| | - Giulio Garaffa
- Institute of Urology, University College London Hospitals, London, UK
| | - Rossella Fucci
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Patrizia Falcone
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Bertocci
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Raffaella Santi
- Department of Pathology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luciana Criscuoli
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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DNA Flow cytometric analysis of the human testicular tissues to investigate the status of spermatogenesis in azoospermic patients. Sci Rep 2018; 8:11117. [PMID: 30042518 PMCID: PMC6057995 DOI: 10.1038/s41598-018-29369-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/09/2018] [Indexed: 11/09/2022] Open
Abstract
A single, rapid and reproducible diagnostic test to predict the type of azoospermia and outcome of sperm retrieval is not yet available. So the feasibility of employing DNA flow cytometry for rapid investigation of the status of spermatogenesis in the patients with azoospermia was investigated. Testicular biopsies of 44 patients with azoospermia undergoing sperm-retrieval surgery and 4 controls were analyzed by flow cytometry to ascertain their testicular germ-cell patterns. The observed germ-cell pattern was further confirmed by RT-PCR analysis of the cell-specific markers and histology for some patients. The patients with Obstructive Azoospermia (OA) exhibited normal spermatogenesis similar to the control fertile patients showing the presence of diploid, double-diploid and haploid cells. The non-obstructive azoospermia (NOA) patients exhibited disrupted spermatogenesis with arrest at the pre-meiotic (only diploid cells present) or meiotic (diploid and double-diploid cells present) stages. The germ-cell pattern, as ascertained by flow cytometry, provided a clear picture of the intra-testicular spermatogenesis and the presence of spermatozoa in the patients’ testes, which was prognostic of their sperm-retrieval. DNA flow cytometry test to ascertain the testicular germ-cell pattern is simple in execution, analysis and interpretation, requires small amount of tissue and provides quantitative data about the status of spermatogenesis in patients. This test would allow comparable analysis of the status of spermatogenesis in patients across clinics and may form the basis for deciding future treatment and intervention strategies.
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Almekaty K, Abomelha S, Thum Y, Nicopoullos J, Bracewell-Milnes T, Yap T, Minhas S. Reporting on longitudinal live birth rates and cumulative delivery rates are more realistic outcome measures than sperm retrieval rates in couples undergoing mTESE-ICSI. HUM FERTIL 2018; 22:139-144. [PMID: 29745280 DOI: 10.1080/14647273.2018.1472396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The live birth rates (LBRs) in men with non-obstructive azoospermia (NOA) undergoing microdissection TESE (mTESE) are under reported, with surgical sperm retrieval rate often used as the primary outcome measure. We analysed longitudinal and cumulative delivery rates following mTESE- intracytoplasmic sperm injection (ICSI) in NOA. Sperm was retrieved in 45% of patients undergoing mTESE. Median male and female age were 42 years (IQR 37-47) and 35 years (IQR 31-38) respectively. A total of 141 ICSI cycles and 23 frozen embryo transfers resulted in 62 pregnancies and 37 LBRs. The longitudinal LBR, crude and expected cumulative delivery rates after five cycles were 15.5%, 48.7% and 71.1%, respectively. Reassuringly, there was no significant difference in pregnancy rate (PR) (p = 0.37) or LBR (p = 0.68) using fresh or frozen sperm or embryo (p = 0.74). Sperm retrieval was significantly correlated with Johnsen score (JS) (p = 0.006) and hypospermatogenesis (HS) (p = 0.04), whilst LBR only significantly correlated with female age (p = 0.04). The longitudinal LBR for a couple embarking on mTESE for azoospermia is only 15.5%, although the cumulative delivery rates are promising. Reassuringly, the outcomes using fresh versus frozen embryos or sperm are comparable. Reporting on delivery rates from a single mTESE procedure are more objective and realistic measures of treatment success in men with NOA.
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Affiliation(s)
- Khaled Almekaty
- a Department of Urology , Tanta University Hospital , Tanta , Egypt
| | - Saad Abomelha
- b Department of Urology , King Fahad National Guard Hospital, King Abdulaziz Medical City , Saudi Arabia
| | - Yau Thum
- c The Lister Hospital , London , UK
| | | | | | - Tet Yap
- d Department of Urology , Guys & St Thomas Hospitals NHS Foundation Trust , London , UK
| | - Suks Minhas
- e Department of Urology , Imperial College NHS Healthcare , London , UK
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Cito G, Coccia ME, Picone R, Cocci A, Criscuoli L, Dabizzi S, Nesi G, Serni S, Carini M, Natali A. Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review. Andrologia 2018; 50:e13022. [DOI: 10.1111/and.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- G. Cito
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. E. Coccia
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - R. Picone
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - A. Cocci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - L. Criscuoli
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - S. Dabizzi
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; Careggi Hospital; University of Florence; Florence Italy
| | - G. Nesi
- Department of Human Pathology and Oncology; Careggi Hospital; University of Florence; Florence Italy
| | - S. Serni
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. Carini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - A. Natali
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
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Cito G, Coccia ME, Dabizzi S, Morselli S, Della Camera PA, Cocci A, Criscuoli L, Picone R, De Carlo C, Nesi G, Micelli E, Serni S, Carini M, Natali A. Relevance of testicular histopathology on prediction of sperm retrieval rates in case of non-obstructive and obstructive azoospermia. Urologia 2018; 85:60-67. [DOI: 10.1177/0391560318758940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The aim of our research was to establish the relevance of testicular histopathology on sperm retrieval after testicular sperm extraction in patients with non-obstructive azoospermia and in patients with obstructive azoospermia, who already underwent a previous failure testicular fine needle aspiration. Methods: We evaluated a total of 82 azoospermic men, underwent testicular sperm extraction, referring to the Assisted Reproductive Technology Centre of the University of Florence, Italy between January 2008 and March 2017. A general and genital physical examination, scrotal and trans-rectal ultrasound, semen analysis, hormone measurements, including follicle-stimulating hormone, luteinizing hormone and total testosterone, were collected. Results: Successful sperm retrieval was obtained in 36 men of total (43.9%). Successful sperm retrieval was 29.5% in non-obstructive azoospermia patients, while men with obstructive azoospermia, who, underwent a previous failure testicular fine needle aspiration, had sperm retrieval in 86% of cases. Mean luteinizing hormone was 6.55 IU/L, total testosterone 4.70 ng/mL, right testicular volume 13.7 mL and left testicular volume 13.6 mL. Mean Follicle-stimulating hormone was 13.45 IU/L in patients with negative sperm retrieval and 8.18 IU/L in men with successful sperm retrieval. According to histology, 20.7% had normal spermatogenesis, 35.3% hypospermatogenesis, 35.3% maturation arrest and 8.5% Sertoli cell-only syndrome. Successful sperm retrieval was 88.2% in patients with normal spermatogenesis, 24.1% in the maturation arrest group and 48.27% in patients with hypospermatogenesis, while negative sperm retrieval was reported in Sertoli cell-only syndrome patients. Seven cases with maturation arrest showed a successful sperm retrieval. Conclusion: Testicular histopathology after testicular sperm extraction offers important information on prediction of sperm retrieval and can guide the surgeon in choosing the more suitable therapeutic practice.
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Affiliation(s)
- Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria E Coccia
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Sara Dabizzi
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Morselli
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pier A Della Camera
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luciana Criscuoli
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Candida De Carlo
- Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy
| | - Gabriella Nesi
- Department of Human Pathology and Oncology, Careggi Hospital, University of Florence, Florence, Italy
| | - Elisabetta Micelli
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Cui Z, Agarwal A, da Silva BF, Sharma R, Sabanegh E. Evaluation of seminal plasma proteomics and relevance of FSH in identification of nonobstructive azoospermia: A preliminary study. Andrologia 2018. [PMID: 29528137 DOI: 10.1111/and.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Nonobstructive azoospermia (NOA) patients present with high levels of serum FSH. At the protein level, the aetiology and pathways underlying different subtypes of NOA are unclear. The aim was to evaluate quantitatively differences in proteomic profiles of NOA patients presenting with normal serum FSH and normal testicular volume and high serum FSH and small testicular volume. The study comprised of 14 nonobstructive azoospermic men (N = 4; normal FSH and normal testicular volume and N = 10; high FSH and small testicular volume) and seven normozoospermic men. Proteomic analysis was done using LC-MS. GSTM3 and PGK2 were less abundant in the normal and high FSH group compared to controls. HSPA4L and HSPA4 were exclusively present in control group whereas HSP90AB1, HSPA1B, HSP90AA1 and HSPA2 were less abundant and exclusive to the normal and high FSH group. We have identified six heat-shock proteins that may have a role in the pathology of NOA. FSH and testicular volume by itself are not good markers of NOA. The inverse association of GSTM3 and PGK2 regulation with FSH levels along with 12 proteins exclusively in NOA groups suggests further evaluation of their predictive potential in a larger cohort of patients.
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Affiliation(s)
- Z Cui
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Institute of Toxicology, Third Military Medical University, Chongqing, China
| | - A Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - B F da Silva
- Human Reproduction Section, Division of Urology, Department of Surgery, São Paulo Federal University, São Paulo, Brazil
| | - R Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - E Sabanegh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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Paulis G, Paulis L, Romano G, Concas C, Di Sarno M, Pagano R, Di Filippo A, Di Petrillo ML. Pregnancy and live birth after follicle-stimulating hormone treatment for an infertile couple including a male affected by Sertoli cell-only syndrome. Res Rep Urol 2017; 9:203-208. [PMID: 29134181 PMCID: PMC5669790 DOI: 10.2147/rru.s148071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In males with nonobstructive azoospermia, one of the main histopathologic patterns of the testis is Sertoli cell-only syndrome (SCOS), in which no germ cells are present and only Sertoli cells are contained in the seminiferous tubules. There is not any formal treatment for this pathological condition. However, several studies reported the possibility to perform testicular sperm extraction in patients with SCOS, although, according to some authors, sperm retrieval is possible only in the presence of focal spermatogenesis. We report the case of an infertile couple in whom the 30-year-old male was azoospermic. After the diagnosis, the patient underwent multiple bilateral testicular biopsies, which showed a histological pattern corresponding to SCOS. We administered a cycle of hormone stimulation followed by medically assisted procreation procedures to the male patient. Therefore, the male patient was treated with follicle-stimulating hormone gonadotropin for a total of 7 months (150 IU recombinant human follicle stimulating hormone three times per week). After carrying out a new multiple testicular sperm extraction, several spermatozoa were microscopically observed, and it was then possible to perform an intracytoplasmic sperm injection with subsequent embryo transfer of the blastocyst into the wife’s uterus, and so pregnancy was established and developed. Subsequently, the pregnancy resulted in the live birth of a girl.
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Affiliation(s)
- Gianni Paulis
- Andrology Center, Regina Apostolorum Hospital, Rome, Italy.,Department of Uro-Andrology, Castelfidardo Medical Team, Peyronie's Disease Care Center, Rome, Italy
| | - Luca Paulis
- Section of Pharmacology and Research, Department of Uro-Andrology, Castelfidardo Medical Team, Peyronie's Disease Care Center, Rome, Italy
| | - Gennaro Romano
- Department of Urologic Oncology, Italian League Against Cancer, Avellino, Italy
| | - Carmen Concas
- Department of Reproductive Medicine and Biology, Caran Center, Caserta, Italy
| | - Marika Di Sarno
- Department of Reproductive Medicine and Biology, Caran Center, Caserta, Italy
| | - Renata Pagano
- Department of Reproductive Medicine and Biology, Caran Center, Caserta, Italy
| | - Antonio Di Filippo
- Department of Reproductive Medicine and Biology, Caran Center, Caserta, Italy
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Tsitlakidis D, Katopodi T, Goulis DG, Papadimas I, Kritis A. Association of follicle-stimulating hormone receptor single nucleotide polymorphisms with fertility in Greek men. J Endocrinol Invest 2017; 40:721-726. [PMID: 28224403 DOI: 10.1007/s40618-017-0637-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Although several epidemiological studies have been conducted, the impact of follicle-stimulating hormone receptor (FSHR) polymorphisms on male infertility remains unclear. The aim of this study was to investigate the prevalence of specific FSHR single nucleotide polymorphisms (SNPs) in the Greek population and associate the latter with the clinical phenotype. PATIENTS AND METHODS We enrolled 96 subjects: men with idiopathic non-obstructive azoospermia (n = 78) were compared with a control group of fertile men (n = 18) for SNPs in FSHR positions c.-29, c.566, c.919, and c.2039. The SNP in position 566 (c.566C > T) was assessed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and the other three SNPs (c.-29G > A, c.919A > G, c.2039A > G) with single-strand conformation polymorphism (SSCP); all of them were validated with DNA sequence. RESULTS No polymorphisms were detected in positions c.-29 and c.919 (c.-29G > A, c.919A > G). The heterozygous SNP (AG) at position 2039 was associated with different size of the right testis (p = 0.008). There was no association between the c.566C > T SNPs polymorphism and hormonal or semen parameters. The combination SNP 2039 AA with 566 CT revealed significant association with FSH and LH concentrations. CONCLUSIONS FSHR SNPs at positions c.-29, c.566, c.919, and c.2039 (c.-29G > A, c.566C > T, c.919A > G, c.2039A > G) do not appear to play specific roles in male infertility. Larger studies are needed to confirm these results.
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Affiliation(s)
- D Tsitlakidis
- Laboratory of Physiology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Diabetologie/Endokrinologie, III Medizinische Klinik, University Klinikum, Jena, Germany.
| | - T Katopodi
- Laboratory of Biology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Papadimas
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Kritis
- Laboratory of Physiology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Althakafi SA, Mustafa OM, Seyam RM, Al-Hathal N, Kattan S. Serum testosterone levels and other determinants of sperm retrieval in microdissection testicular sperm extraction. Transl Androl Urol 2017; 6:282-287. [PMID: 28540237 PMCID: PMC5422690 DOI: 10.21037/tau.2017.02.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Microdissection 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. Methods This 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. Results Sperms 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. Conclusions Serum 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.
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Affiliation(s)
- Sultan A Althakafi
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia.,Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Osama M Mustafa
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Raouf M Seyam
- Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Naif Al-Hathal
- Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Said Kattan
- Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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44
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Salehi P, Derakhshan-Horeh M, Nadeali Z, Hosseinzadeh M, Sadeghi E, Izadpanahi MH, Salehi M. Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients. Clin Exp Reprod Med 2017; 44:22-27. [PMID: 28428940 PMCID: PMC5395548 DOI: 10.5653/cerm.2017.44.1.22] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/05/2017] [Accepted: 02/02/2017] [Indexed: 12/03/2022] Open
Abstract
Objective Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval. Methods We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome. Results The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (p<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; p<0.01). A logistic regression model demonstrated that high levels of follicle-stimulating hormone (FSH) and small testicular volume were significantly associated with lower chances of successful sperm retrieval. Conclusion Some parameters, including testicular histopathology patterns, FSH levels, testicular volume, and method of TESE surgery, may be able to predict the chances of obtaining spermatozoa in patients with NOA. However, despite the efficiency of some predictive models, the hope of retrieving any functioning spermatozoa may be sufficient to disregard predictive factors of the success of intracytoplasmic sperm injection in these patients.
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Affiliation(s)
- Peyman Salehi
- Shahid Beheshti Infertility Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Zakiye Nadeali
- Medical Genetics Laboratory, Al-Zahra University Hospital, Isfahan, Iran
| | - Majid Hosseinzadeh
- Medical Genetics Laboratory, Al-Zahra University Hospital, Isfahan, Iran.,Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Department of Biostatistics and Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mansour Salehi
- Medical Genetics Laboratory, Al-Zahra University Hospital, Isfahan, Iran.,Department of Genetics and Molecular Biology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Verheyen G, Popovic-Todorovic B, Tournaye H. Processing and selection of surgically-retrieved sperm for ICSI: a review. Basic Clin Androl 2017; 27:6. [PMID: 28331619 PMCID: PMC5360083 DOI: 10.1186/s12610-017-0050-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/01/2017] [Indexed: 12/30/2022] Open
Abstract
Although the technique of intracytoplasmic sperm injection (ICSI) has been a revolution in the alleviation of male infertility, the use of testicular sperm for ICSI was a formerly unseen breakthrough in the treatment of the azoospermic man with primary testicular failure. At the clinical level, different procedures of testicular sperm retrieval (conventional TESE, micro-TESE, FNA/TESA, MESA, PESA) are being performed, the choice is mainly based on the cause of azoospermia (obstructive versus non-obstructive) and the surgeon's skills. At the level of the IVF laboratory, mechanical procedures to harvest the sperm from the tissue may be combined with enzymatic treatment in order to increase the sperm recovery rates. A number of techniques have been developed for viable sperm selection in males with only immotile testicular sperm available. However, large, well-designed studies on the benefit and safety of one over the other technique are lacking. Despite all the available methods and combinations of laboratory procedures which have a common goal to maximize sperm recovery from testicular samples, a large proportion of NOA patients fail to father a genetically own child. Advanced technology application may improve recovery rates by detection of the testicular foci with active spermatogenesis and/or identification of the rare individual sperm in the testicular suspensions. On the other hand, in vitro spermatogenesis or sperm production from embryonic stem cells or induced pluripotent stem cells might be future options. The present review summarizes the available strategies which aim to maximize sperm recovery from surgically retrieved samples.
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Affiliation(s)
- Greta Verheyen
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | | | - Herman Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
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Alhalabi M. Predictive value of serum Inhibin-B levels as an indicator of the presence of testicular spermatozoa in non-obstructive azoospermia. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Esteves SC. Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 2016; 33:1319-1335. [PMID: 27423664 PMCID: PMC5065546 DOI: 10.1007/s10815-016-0763-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organization (WHO) laboratory methods and reference values for the examination of human semen. Second, we examine the role of sperm chromatin integrity tests in light of increasing evidence of the detrimental effect of sperm DNA fragmentation on reproductive outcomes. Third, we summarize the main findings of varicocele-related infertility and the outcomes of microsurgical varicocele repair to different case scenarios. Lastly, we critically discuss the current management of men with nonobstructive azoospermia seeking fertility and the new opportunities that emerged to help these men achieve biological fatherhood.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Av. Dr. Heitor Penteado, 1464, Campinas, SP, 13075-460, Brazil.
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Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes. PLoS One 2016; 11:e0163524. [PMID: 27661081 PMCID: PMC5035010 DOI: 10.1371/journal.pone.0163524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 09/09/2016] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Spermatozoa motility is the critical parameter to affect the treatment outcomes during assisted reproductive technologies (ART), but its reproductive capability remains a little informed in condition of severe male factor infertility. This retrospective cohort study aimed to evaluate the effects of reduced sperm motility on the embryological and clinical outcomes in intra-cytoplasmic sperm injection (ICSI) treatment of severe oligozoospermia. PATIENTS AND METHODS 966 cycles (812 couples) of severe oligozoospermia diagnosed by spermatozoa count ≤ 5 × 106/mL and motile spermatozoa ≤ 2 × 106/mL were divided into four groups in according to the number of motile spermatozoa in one ejaculate on the day of oocyte retrieval (Group B-E). The control (Group A) was 188 cycles of moderate oligozoospermia with spermatozoa count > 5 × 106/mL and motile spermatozoa > 2 × 106/mL. All female partners were younger than 35 years of age. Logistic regression analyzed embryological outcomes (the rates of fertilization, cleavage and good-quality embryo) and clinical outcomes (the rates of pregnancy, implantation, early miscarriage and live birth). Quality of embryo transfer (ET) was divided into three classes as continuous factor to test the effects of embryo quality on clinical outcomes. RESULTS The reduction in the number of motile sperm in four groups of severe oligozoospermia gave rise to comparable inability of the fertilization (p < 0.001) and a decreased rate of good-quality embryo at Day 3 (p < 0.001) by compared to the control. The cleavage rate of the derived zygotes was similar to the control. ET classes significantly affected the clinical outcomes (p < 0.001). Class I ET gave rise to similar rates of clinical outcomes between five groups, but Class II and Class III ET retarded the rates of pregnancy, implantation and live birth and this particularly occurred in Group C, D and E. The rate of early miscarriage was not comparably different between groups. Overall rates in all groups were 41.26% clinical pregnancy, 25.74% implantation and 36.32% live birth, which gave live birth to 252 girls and 252 boys. CONCLUSIONS The reduction of motile spermatozoa in severe oligozoospermia decreased the rates of fertilization and good-quality embryo. Obtaining and transfer of good-quality embryos was the good prognostic to achieve prospective clinical outcomes regardless of the severity of oligozoospermia.
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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. J Assist Reprod Genet 2016; 34:149-154. [PMID: 27655389 DOI: 10.1007/s10815-016-0812-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE). METHODS We retrospectively evaluated 356 patients with non-obstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve. RESULTS The mean patients' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and -LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001) CONCLUSIONS: This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.
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