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Majzoub A, Viana MC, Achermann APP, Ferreira IT, Laursen RJ, Humaidan P, Esteves SC. Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring. J Clin Med 2024; 13:4939. [PMID: 39201081 PMCID: PMC11355217 DOI: 10.3390/jcm13164939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This review summarizes the chances of success with ICSI for NOA patients and examines preoperative factors and laboratory techniques associated with positive outcomes. Furthermore, we reviewed possible consequences for offspring by the use of ICSI with testicular sperm retrieved from NOA patients and the interventions that could potentially mitigate risks. Testicular sperm retrieved from NOA patients may exhibit increased chromosomal abnormalities, and although lower fertilization and pregnancy rates are reported in NOA patients compared to other forms of infertility, the available evidence does not suggest a significant increase in miscarriage rate, congenital malformation, or developmental delay in their offspring compared to the offspring of patients with less severe forms of infertility or the offspring of fertile men. However, due to limited data, NOA patients should receive specialized reproductive care and personalized management. Counseling of NOA patients is essential before initiating any fertility enhancement treatment not only to mitigate health risks associated with NOA but also to enhance the chances of successful outcomes and minimize possible risks to the offspring.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha 3050, Qatar;
- Department of Clinical Urology, Weill Cornell Medicine-Qatar, Doha 3050, Qatar
| | - Marina C. Viana
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
| | - Arnold P. P. Achermann
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
| | - Isadora T. Ferreira
- Faculty of Medical Sciences, Pontifical Catholic University of Campinas, Campinas 13087-571, SP, Brazil;
| | - Rita J. Laursen
- Skive Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark; (R.J.L.); (P.H.)
| | - Peter Humaidan
- Skive Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark; (R.J.L.); (P.H.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Sandro C. Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil; (M.C.V.); (A.P.P.A.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Surgery, Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
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Lv MQ, Yang YQ, Li YX, Zhou L, Ge P, Sun RF, Zhang J, Gao JC, Qu LQ, Jing QY, Li PC, Yan YJ, Wang HX, Li HC, Zhou DX. A detection model of testis-derived circular RNAs in serum for predicting testicular sperm retrieval rate in non-obstructive azoospermia patients. Andrology 2024. [PMID: 38421140 DOI: 10.1111/andr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Microdissection testicular sperm extraction is an effective method to retrieve sperm from non-obstructive azoospermia patients. However, its successful rate is less than 50%. OBJECTIVES To identify the predictive value of circular RNAs in serum for sperm retrieval rate in non-obstructive azoospermia patients. MATERIALS AND METHODS 180 non-obstructive azoospermia patients were recruited in this study, including 84 individuals with successful sperm retrieval and 96 individuals with failed sperm retrieval. Our study contained two phases. First, 20 patients, selected from the 180 patients, were included in screening cohort. In this cohort, the top 20 circular RNAs from our previous testicular circRNA profiles were verified between successful and failed sperm retrieval groups using real-time polymerase chain reaction. Six circular RNAs with the most significantly different expressions were selected for further verification. Second, the 180 patients were included as discovery cohort to verify the six circular RNAs. Circular RNAs were extracted from serum in each participant. Logistic regression analysis was further performed to identify the predictive value and the area under the curve analysis was used to evaluate diagnostic efficiency, sensitivity, and specificity. RESULTS Six circular RNAs including hsa_circ_0058058, hsa_circ_0008045, hsa_circ_0084789, hsa_circ_0000550, hsa_circ_0007422, and hsa_circ_0004099 showed aberrant expressions between the successful and failed sperm retrieval group. In addition, both single-circular RNA panels and multi-circular RNA panels were finally verified to be significant in predicting sperm retrieval rate. Notably, multi-circular RNAs panels demonstrated better predictive abilities compared with single-circRNA panels, and the combined panel of six-circular RNAs (risk score = 1.094×hsa_circ_0058058+0.697×hsa_circ_0008045+0.718×hsa_circ_0084789-0.591×hsa_circ_0000550-0.435×hsa_circ_0007422-1.017×hsa_circ_0004099-1.561) exhibited the best predictive ability in the present study with an AUC of 0.977, a sensitivity of 91.7% and a specificity of 86.5%. A higher risk score indicated a higher risk of failure in sperm retrieval. DISCUSSION AND CONCLUSION Our study was the first to report that testis-derived circular RNAs in serum have the ability to predict sperm retrieval rate in non-obstructive azoospermia patients, whether it is a single-circular RNA or a combination of multi-circular RNAs.
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Affiliation(s)
- Mo-Qi Lv
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Yan-Qi Yang
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Yi-Xin Li
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Zhou
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Pan Ge
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Rui-Fang Sun
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Jian Zhang
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Jun-Cheng Gao
- School of Humanities and Social Development, Northwest A&F University, Xianyang, China
| | - Liu-Qing Qu
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Qi-Ya Jing
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Pin-Cheng Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yu-Jia Yan
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Hai-Xu Wang
- Assisted Reproduction Center, Xijing Hospital of Air Force Medical University (the former the Fourth Military Medical University), Xi'an, China
| | - He-Cheng Li
- Department of Urology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dang-Xia Zhou
- Department of Pathology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Institute of Genetics and Development, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
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Lustgarten Guahmich N, Borini E, Zaninovic N. Improving outcomes of assisted reproductive technologies using artificial intelligence for sperm selection. Fertil Steril 2023; 120:729-734. [PMID: 37307892 DOI: 10.1016/j.fertnstert.2023.06.009] [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: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
Within the field of assisted reproductive technology, artificial intelligence has become an attractive tool for potentially improving success rates. Recently, artificial intelligence-based tools for sperm evaluation and selection during intracytoplasmic sperm injection (ICSI) have been explored, mainly to improve fertilization outcomes and decrease variability within ICSI procedures. Although significant advances have been achieved in developing algorithms that track and rank single sperm in real-time during ICSI, the clinical benefits these might have in improving pregnancy rates from a single assisted reproductive technology cycle remain to be established.
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Affiliation(s)
- Nicole Lustgarten Guahmich
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Elena Borini
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Nikica Zaninovic
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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Patel SR, Park B, Reddy A, Fisher S, Rivera Mirabal JL, Lipshultz LI. Testicular Core Extraction: Important Technique for Determining Sperm Retrieval Method in Non-obstructive Azoospermia. Urology 2023; 173:87-91. [PMID: 36574908 DOI: 10.1016/j.urology.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/28/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the value of preliminary testicular core extraction (TCE) as a tool for determining whether to pursue clinic testicular extraction (cTESE) versus microscopic testicular sperm extraction (mTESE) to minimize both financial burden and procedural complexity. METHODS All men with non-obstructive azoospermia (NOA) from 2018 to 2022 who underwent clinic TCE were analyzed. Patients who were found to have sperm on initial TCE were recommended cTESE. Patients who did not have sperm on initial TCE were recommended for mTESE. Sensitivity, specificity, positive predictive value, and negative predictive value of TCE were calculated. Cost reductions were determined based on this institution's fees. A nonparametric Wilcoxon test was performed to determine statistical significance between the results of the TCE sperm present and sperm absent groups. RESULTS Of the 82 NOA patients undergoing TCE, 51 (62.2%) core biopsies were positive for sperm and 31 (37.8%) were negative for sperm. The SRR for 35 men who then underwent cTESE following sperm seen on TCE was 97.1%. The SRR for 8 men who underwent mTESE after no sperm was found on TCE was 75%. The positive predictive value of TCE for successful TESE result is 94.4% for men with NOA. Treatment success rate of TCE and cTESE was 79.1% with a cost reduction of 59.4%. CONCLUSION TCE is a prognostic tool to guide decision making between cTESE and mTESE and maximize sperm retrieval rate while mitigating financial burden and operative complexity. TCE is important to identify ideal candidates for both procedures to maximize efficacy and safety amongst men with NOA.
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Affiliation(s)
- Sagar R Patel
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Bridget Park
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Amit Reddy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Sam Fisher
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Arian I, Dumbraveanu I, Ghenciu V, Machidon D, Ernu I, Ceban E. Histological and immunohistochemical outcomes after microdissection TESE in contrast with hormonal profile, testis volume and genetics in patients with azoospermia. J Med Life 2023; 16:144-152. [PMID: 36873127 PMCID: PMC9979170 DOI: 10.25122/jml-2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/08/2023] [Indexed: 03/07/2023] Open
Abstract
A limited number of individuals with non-obstructive azoospermia (NOA) may recover spermatozoa through traditional testicular sperm extraction (TESE) techniques. There is an ongoing debate over the effectiveness of microdissection TESE compared to standard TESE methods. Microdissection TESE (micro-TESE) techniques enable the identification of spermatogenesis foci in non-obstructive forms of azoospermia. Only histological examination can provide an objective and definitive assessment of the testicular phenotype. This study aimed to evaluate the correlation between histopathological findings after microdissection TESE (micro-TESE) and the predictive role of various factors in determining the success of sperm retrieval. We evaluated 24 patients with azoospermia who underwent micro-TESE and considered the patient's hormonal profile, testis ultrasound, genetic evaluation, histology, and immunohistology (PLAP antibody) of collected testis biopsies. The preoperative blood FSH level, in conjunction with other parameters, may aid in the prediction of micro-TESE success. Sensitivity increases, and specificity decreases with higher FSH levels. Furthermore, testicular volume and FSH levels are typically normal in patients with maturation arrest. In conclusion, hormones, ultrasound evaluation of the testicles, testis volume, and available genetic tests have a predictive value in differentiating obstructive azoospermia (OA) from NOA with various sensitivity and specificity rates. Histological and immunohistochemical evaluation establishes the testicular phenotype accurately and guides patient management.
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Affiliation(s)
- Iurii Arian
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Ion Dumbraveanu
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Victoria Ghenciu
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Daniela Machidon
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Ion Ernu
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Emil Ceban
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
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6
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Hugues J. Stratégies de prise en charge des azoospermies non obstructives relevant d’une atteinte testiculaire primitive. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Li JP, Du CQ, Liu ZB, Zhang FB, Li LJ, Wu JG, Tian YH, Liang ZY, Chen C, Jin F. Development and validation predictive models of sperm retrieval for azoospermic men undergoing testicular sperm aspiration: a multicentre, retrospective, cohort study. J Assist Reprod Genet 2022; 39:1779-1787. [PMID: 35870097 PMCID: PMC9428087 DOI: 10.1007/s10815-022-02531-y] [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: 02/21/2022] [Accepted: 05/26/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Testicular sperm aspiration (TESA) is widely used to retrieve sperm from testis. Diagnostic testicular biopsy should not be routinely performed for azoospermia. Therefore, a good predictive model is needed before TESA. METHODS A total of 1972 azoospermia patients constituted the modelling set, and 260 azoospermia patients from two other centres constituted the validation set. An integrated predictive model was built using logistic regression. Receiver operating characteristic (ROC), calibration and decision curve analyses were performed to evaluate the performance of follicle-stimulating hormone (FSH), semen volume, testicular volume and the integrated model. RESULTS The FSH level was the best univariate predictor for successful sperm retrieval (SSR) and was better than semen volume and testicular volume alone (p<0.001, threshold 6.17 IU/L, modelling set area under receiver operating characteristic curve (AUC) 0.80, accuracy 0.79; validation set AUC 0.87, accuracy 0.78). The integrated predictive model had excellent accuracy for predicting SSR (modelling set: AUC 0.93, accuracy 0.89; validation set: AUC 0.96, accuracy: 0.89). Calibration curve analysis indicated that the integrated model calibration was good and better than that of FSH, semen volume and testicular volume alone. Decision curve analysis indicated with a threshold probability between 0.05 and 0.98, the integrated model added more benefit than treating either all or no patients. CONCLUSIONS The integrated model has excellent discrimination and good calibration. It can help azoospermic men make better decisions before TESA. It should be noted that TESA is not the first-line treatment for non-obstructive azoospermia because of a low sperm retrieval rate.
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Affiliation(s)
- Jing-Ping Li
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Cong-Qi Du
- grid.13402.340000 0004 1759 700XReproductive Medicine Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Zu-Bo Liu
- grid.513202.7Reproductive Medicine Centre, Jinhua People’s Hospital, Jinhua, People’s Republic of China
| | - Feng-Bin Zhang
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Le-Jun Li
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Jing-Gen Wu
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Yong-Hong Tian
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Zhong-Yan Liang
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Chong Chen
- grid.13402.340000 0004 1759 700XDepartment of Ultrasound, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Fan Jin
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
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Li L, Liao H, Li M, Xiao J, Wu L. Comparative Clinical Study of Percutaneous Epididymal Sperm Aspiration and Testicular Biopsy in the Outcome of ICSI-Assisted Fertility Treatment in Patients with Obstructive Azoospermia. Front Surg 2022; 9:901601. [PMID: 36034342 PMCID: PMC9407240 DOI: 10.3389/fsurg.2022.901601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare and contrast the effects of percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) on the outcome of intracytoplasmic sperm injection (ICSI)-assisted fertility treatment in patients with obstructive azoospermia. Methods Patients with obstructive azoospermia with an age distribution of 20–36 years admitted to the male department of the Reproductive Center of the Second Affiliated Hospital of South China University (Hengyang Nanhua Xing Hui Reproductive Health Hospital) from December 2018 to December 2020 were used in this study. One group was set up as the PESA group to perform PESA, and the other group was set up as the TESA group to perform percutaneous testicular biopsy for sperm extraction. Patients who were unsuccessful in PESA continued to undergo TESA, and if sperm were retrieved, they were classified as the TESA group. General information on male patients and their partners was collected and compared in patients from different sperm source groups. Embryo development (normal fertilization rate, high-quality embryo rate, and high-quality blastocyst rate) and pregnancy outcome (clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate) were compared between the two groups. Results Finally, there were 26 patients in the PESA group and 31 patients in the TESA group. There were no significant differences in terms of age, years of infertility, testosterone level, (FSH) follicle-stimulating hormone level, and testicular volume between the male patients in the PESA and TESA groups of two different sperm sources, and no significant differences were found in the general conditions of the female patients in terms of age, number of eggs obtained, number of sinus follicles, basal FSH value, and basal E2 value (p > 0.05). The rate of high-quality blastocysts in the TESA group was significantly higher than that in the PESA group (p < 0.05); the differences in clinical normal fertilization rate, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate between the two groups were not statistically significant (p > 0.05). Conclusion ICSI with different sources of sperm in patients with male factor infertility alone, which had no significant effect on embryo development, embryo implantation rate, clinical pregnancy rate, and miscarriage rate, resulting in better clinical outcomes.
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Affiliation(s)
- Lian Li
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Hongqing Liao
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Meiqing Li
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Jianghua Xiao
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Lei Wu
- Department of Urology Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Correspondence: Lei Wu
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9
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Esteves SC. Microdissection TESE versus conventional TESE for men with nonobstructive azoospermia undergoing sperm retrieval. Int Braz J Urol 2022; 48:569-578. [PMID: 35333489 PMCID: PMC9060172 DOI: 10.1590/s1677-5538.ibju.2022.99.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Clínica de Andrologia e Reprodução Humana, Campinas, SP, Brasil.,Departamento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,3 Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark
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10
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Ji C, Wang Y, Wei X, Zhang X, Cong R, Yao L, Qin C, Song N. Potential of testis-derived circular RNAs in seminal plasma to predict the outcome of microdissection testicular sperm extraction in patients with idiopathic non-obstructive azoospermia. Hum Reprod 2021; 36:2649-2660. [PMID: 34477868 DOI: 10.1093/humrep/deab196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Do testis-derived circular RNAs (circRNAs) in seminal plasma have potential as biomarkers to predict the outcome of microdissection testicular sperm extraction (micro-TESE) in patients with idiopathic non-obstructive azoospermia (NOA)? SUMMARY ANSWER Testis-derived circRNAs in the seminal plasma can indeed be used for predicting the outcome of micro-TESE in patients with idiopathic NOA. WHAT IS KNOWN ALREADY Micro-TESE is an effective method to obtain sperm samples from patients with idiopathic NOA. However, its success rate is only 40-50% in such patients. STUDY DESIGN, SIZE, DURATION Six idiopathic NOA patients with different micro-TESE results were included as the discovery cohort. Their testicular tissues were used for extracting and sequencing circRNAs. Five circRNAs with the most significantly different expression levels were selected for further verification. PARTICIPANTS/MATERIALS, SETTING, METHODS Fifty-two patients with idiopathic NOA were included as the validation cohort. Preoperative seminal plasma samples of 52 patients with idiopathic NOA and 25 intraoperative testicular tissues were collected and divided into 'success' and 'failure' groups according to the results of micro-TESE. Quantitative real-time polymerase chain reaction was performed to verify differences in the expression levels of the selected circRNAs between the two groups in the testicular tissues and seminal plasma. MAIN RESULTS AND THE ROLE OF CHANCE Whether at the seminal plasma or testicular tissue level, the differences in the expression levels of the three circRNAs (hsa_circ_0000277, hsa_circ_0060394 and hsa_circ_0007773) between the success and failure groups were consistent with the sequencing results. A diagnostic receiver operating curve (ROC) analysis of the AUC indicated excellent diagnostic performance of these circRNAs in seminal plasma in predicting the outcome of micro-TESE (AUC values: 0.920, 0.928 and 0.891, respectively). On the basis of least absolute shrinkage and selection operator (LASSO) logistic regression, the three circRNAs were combined to construct a new prediction model. The diagnostic ROC curve analysis of the model showed an AUC value of 0.958. The expression levels of these circRNAs in seminal plasma using three normospermic volunteer samples remained stable after 48 h at room temperature. LARGE SCALE DATA NA. LIMITATIONS, REASONS FOR CAUTION This was a single-center retrospective study with relatively few cases. The functions of these circRNAs, as well as their relationship with spermatogenesis, have not yet been established. WIDER IMPLICATIONS OF THE FINDINGS Testis-derived circRNAs in seminal plasma can reflect the microenvironment of the testis and can be used as reliable biomarkers to screen patients with idiopathic NOA who might be suitable for micro-TESE. STUDY FUNDING/COMPETING INTEREST(S) This article was funded by the National Natural Science Foundation of China (Grant no. 81871151). There were no competing interests.
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Affiliation(s)
- Chengjian Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yichun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiyi Wei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xingyu Zhang
- State Key Laboratory of Reproductive Medicine, Department of Histology and Embryology, Nanjing Medical University, Nanjing, China
| | - Rong Cong
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Liangyu Yao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.,Department of Urology, The Affiliated Kezhou People's Hospital of Nanjing Medical University, Xinjiang, China
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11
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Zarezadeh R, Fattahi A, Nikanfar S, Oghbaei H, Ahmadi Y, Rastgar Rezaei Y, Nouri M, Dittrich R. Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia. J Assist Reprod Genet 2021; 38:2049-2059. [PMID: 33791895 PMCID: PMC8417206 DOI: 10.1007/s10815-021-02176-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/28/2021] [Indexed: 12/12/2022] Open
Abstract
Non-obstructive azoospermia (NOA) is one of the leading causes of male factor infertility, which results from impaired spermatogenesis. Currently, the sole feasible therapeutic option for men with NOA to father their biologic children is sperm retrieval by testicular sperm extraction (TESE) approaches followed by an intracytoplasmic sperm injection program. Nevertheless, the rate of sperm retrieval from NOA men following TESE has remained as low as 50%, leading to a significant number of unsuccessful TESE operations. Given that TESE is associated with multiple side effects, the prediction of TESE outcome preoperatively can abolish unnecessary operations and thereby prevent NOA patients from sustaining adverse side effects. As the process of spermatogenesis is under the regulation of hormones, the hormonal profile of serum and/or seminal plasma may contain useful information about spermatogenesis status and can potentially predict the chance of sperm retrieval from NOA patients. A large body of literature is available on the predictive capability of different serum and seminal plasma hormones such as FSH, LH, testosterone, inhibin B, AMH, estradiol, prolactin, and leptin in a stand-alone basis or combinational fashion with respect to the TESE outcome. The present review aimed to evaluate the potential of these hormonal markers as noninvasive predictors of sperm retrieval in men with NOA.
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Affiliation(s)
- Reza Zarezadeh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Nikanfar
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hajar Oghbaei
- Department of Physiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Ahmadi
- Department of Urology, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yeganeh Rastgar Rezaei
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen–Nürnberg, Erlangen, Germany
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12
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Andrade DL, Viana MC, Esteves SC. Differential Diagnosis of Azoospermia in Men with Infertility. J Clin Med 2021; 10:3144. [PMID: 34300309 PMCID: PMC8304267 DOI: 10.3390/jcm10143144] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.
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Affiliation(s)
- Danilo L Andrade
- Department of Medical Physiopathology (Postgraduate Program), State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Marina C Viana
- Department of Surgery (Residency Program), Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil
- Department of Surgery, Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
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13
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Tradewell MB, Masterson TA. Nonobstructive azoospermia: a spectrum, not a single disease. Fertil Steril 2020; 115:315. [PMID: 33039129 DOI: 10.1016/j.fertnstert.2020.09.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael B Tradewell
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Masterson
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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