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El Ansari W, Arafa M, Lock M, Shah R, Agarwal A. Effectiveness of, and Satisfaction with, a Microsurgical Testicular Sperm Extraction Knowledge and Skills Masterclass for a World-Wide Audience. World J Mens Health 2024; 42:574-586. [PMID: 38164026 PMCID: PMC11216970 DOI: 10.5534/wjmh.230195] [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: 07/14/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE This is the first study to assess the impact of an online microsurgical testicular sperm extraction (mTESE) masterclass. We: 1) describe the masterclass's scientific content; 2) appraise the participants' acquisition of knowledge; 3) gauge whether the extent of improvement of the participants' knowledge/skills was influenced by demographic/professional attributes; and 4) evaluate the participants' satisfaction. MATERIALS AND METHODS This masterclass comprised five didactic lectures followed by 4 case discussions. Online surveys assessed the above objectives using a baseline questionnaire including demographics and past mTESE experience/training, a 24-question pre- and post-quiz, and a satisfaction questionnaire. RESULTS Participants were between 20-70 years old, with 80.37% males, mainly from Asia, Africa, and Europe, from clinical backgrounds (69.3%), and in public practice (64.4%). Half the sample reported no past mTESE training and very low skills, ≈60% wanted considerably more training, and 50% felt that good training was not readily available. Satisfaction was 98% to >99%. Pre- and post-quiz comparisons confirmed remarkable improvements in knowledge/skills, exhibiting five striking characteristics. Improvements were a) Broad i.e., across 19 of the 24 mTESE questions; b) Deep, of magnitude, as pre-/post-quiz scores improved from mean 13.71±4.13 to 17.06±4.73; c) Highly significant, consistently with p-values <0.001; d) Inclusive i.e., all participants enhanced their mTESE knowledge/skills regardless of demographic/professional attributes; and, e) Differential, e.g., non-clinical/clinical participants improved, but the former improved relatively significantly more, those with ≤5-year experience improved significantly more than those with >5-year, those in public practice significantly more than private practice participants, and those with lower self-rating in performing mTESE significantly more than those with higher self-rating. CONCLUSIONS The masterclass was successful with very high satisfaction levels, and markedly improved mTESE knowledge/skills among the participants. Global Andrology Forum's model can be adopted by organizations with similar goals. Future research needs to evaluate such training to develop a practically non-existent evidence base.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Postgraduate Medical Education, College of Medicine, Qatar University, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Andrology, Cairo University, Cairo, Egypt
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Merilyn Lock
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- Well Women Centre, Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic, Cleveland, OH, USA.
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Zhang F, Dai M, Yang X, Cheng Y, Ye L, Huang W, Chen X, Yin T, Sha Y. Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non-obstructive azoospermia: A systematic review and meta-analysis. Andrology 2024; 12:30-44. [PMID: 37172416 DOI: 10.1111/andr.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/22/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND There has been no systematic review and meta-analysis to analyze and summarize the predictive factors of successful sperm extraction in salvage microdissection testicular sperm extraction. OBJECTIVES We aimed to investigate the factors predicting the result of salvage microdissection testicular sperm extraction in patients with non-obstructive azoospermia who failed the initial microdissection testicular sperm extraction or conventional testicular sperm extraction. MATERIALS AND METHODS We conducted a systematic literature search in PubMed, Web of Science, EMBASE, and the Cochrane Library for literature that described the characteristics of patients with non-obstructive azoospermia who underwent salvage microdissection testicular sperm extraction after failing the initial microdissection testicular sperm extraction or conventional testicular sperm extraction published prior to June 2022. RESULTS This meta-analysis included four retrospective studies with 332 patients with non-obstructive azoospermia who underwent a failed initial microdissection testicular sperm extraction and three retrospective studies with 177 non-obstructive azoospermia patients who underwent a failed conventional testicular sperm extraction. The results were as follows: among non-obstructive azoospermia patients whose first surgery was microdissection testicular sperm extraction, younger patients (standard mean difference: -0.28, 95% confidence interval [CI]: -0.55 to -0.01) and those with smaller bilateral testicular volume (standard mean difference: -0.55, 95% CI: -0.95 to -0.15), lower levels of follicle-stimulating hormone (standard mean difference: -0.86, 95% CI: -1.18 to -0.54) and luteinizing hormone (standard mean difference: -0.68, 95% CI: -1.16 to -0.19), and whose testicular histological type was hypospermatogenesis (odds ratio: 3.52, 95% CI: 1.30-9.53) were more likely to retrieve spermatozoa successfully, while patients with Sertoli-cell-only syndrome (odds ratio: 0.41, 95% CI: 0.24-0.73) were more likely to fail again in salvage microdissection testicular sperm extraction. Additionally, in patients who underwent salvage microdissection testicular sperm extraction after a failed initial conventional testicular sperm extraction, those with testicular histological type of hypospermatogenesis (odds ratio: 30.35, 95% CI: 8.27-111.34) were more likely to be successful, while those with maturation arrest (odds ratio: 0.39, 95% CI: 0.18-0.83) rarely benefited. CONCLUSION We found that age, testicular volume, follicle-stimulating hormone, luteinizing hormone, hypospermatogenesis, Sertoli-cell-only syndrome, and maturation arrest were valuable predictors of salvage microdissection testicular sperm extraction, which will assist andrologists in clinical decision-making and minimize unnecessary injury to patients.
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Affiliation(s)
- Feng Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengyang Dai
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinyuan Yang
- Department of Nursing, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China
| | - Yumeng Cheng
- College of Pharmacy, Tianjin Medical University, Tianjin, China
| | - Lijun Ye
- Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Wensi Huang
- Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Xi Chen
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yanwei Sha
- Department of Andrology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
- Fujian Provincial Key Laboratory of Reproductive Health Research, School of Medicine, Xiamen University, Xiamen, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
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Kim TJ, Koo KC. Testosterone to Luteinizing Hormone Ratio as a Potential Predictor of Sperm Retrieval in Non-Obstructive Azoospermia Patients. Yonsei Med J 2023; 64:433-439. [PMID: 37365737 DOI: 10.3349/ymj.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE This study assessed the outcomes of microsurgical testicular sperm extraction (mTESE) and potential preoperative predictors of sperm retrieval (SR) in patients with non-obstructive azoospermia (NOA). MATERIALS AND METHODS Clinical data of 111 NOA patients who underwent mTESE was reviewed retrospectively. Baseline patient characteristics, including age, body mass index (BMI), testicular volumes, and preoperative endocrine levels, such as testosterone (T), follicle-stimulating hormone (FSH), serum-luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), FSH/LH ratio along with T/LH ratio, were analyzed. After categorizing the patients into two groups based on SR success or failure, logistic regression analysis was performed to identify the preoperative predictors of successful SR. RESULTS Sixty-eight patients had successful SR (61.3%), whereas 43 patients (38.7%) showed negative results. Failed SR group had elevated serum FSH and LH levels, whereas successful SR patients had a significantly larger testicular volume (p<0.001). Moreover, the successful group had a higher T/LH ratio (p<0.001). Multivariate logistic analysis showed that the T/LH ratio, serum FSH levels, and bilateral testicular volumes were significantly associated with successful sperm extraction. CONCLUSION In addition to traditional predictors, such as testicular volume and preoperative FSH levels, the T/LH ratio is a potential independent predictor of successful SR in infertile patients with NOA.
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Affiliation(s)
- Tae Jin Kim
- Department of Urology, CHA University Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Salama N, Sirelkhatim Hassan O. Staged Laboratory Processing of Testicular Tissue in Non-Obstructive Azoospermia May Rescue Retrieving an Existing Sperm: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231178353. [PMID: 37275676 PMCID: PMC10233592 DOI: 10.1177/11795476231178353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/29/2023] [Indexed: 06/07/2023]
Abstract
Non-obstructive azoospermia (NOA) is the most difficult form of male infertility to manage. It usually requires sperm retrieval from the testis, which is most challenging due to sperm rarity. Here, we describe the recovery of testicular sperms that had been missing and whose original retrieval results were negative. Salvage microsurgical testicular sperm extraction and sperm testing were performed on a 36-year-old male with NOA. Neither in the operation room nor after an inspection in the embryology laboratory were any sperm detected. The obtained tissue was advised to be frozen because the patient data and surgical microscopy predicted a favorable outcome, and the tissue processing was done in an inappropriate environment. About 1 month later, the specimen was thawed, crushed, and re-examined. Successful oocyte fertilization resulted from an effective detection of sperms and their direction to intra-cytoplasmic sperm injection. This is the first case report that, to the best of our knowledge, describes the stepwise laboratory processing of testicular tissue and its capacity to recover lost sperms in challenging NOA cases and under less-than-ideal working conditions.
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Affiliation(s)
- Nader Salama
- Department of Urology, Alexandria
Faculty of Medicine, Alexandria, Egypt
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Major N, Edwards KR, Simpson K, Rogers M. An examination of predictive markers for successful sperm extraction procedures: a linear model and systematic review. Asian J Androl 2023; 25:38-42. [PMID: 35645045 PMCID: PMC9933960 DOI: 10.4103/aja202221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/29/2022] [Indexed: 01/19/2023] Open
Abstract
The authors performed a comprehensive review of current literature to create a model comparing commonly evaluated variables in male factor infertility, for example, follicle-stimulating hormone (FSH), testicular volume (TV), and testosterone (T), to better predict sperm retrieval rate (SRR). Twenty-nine studies were included, 9 with data on conventional testicular sperm extraction (cTESE) for a total of 1227 patients and 20 studies including data on microdissection testicular sperm extraction (mTESE) for a total of 4760 patients. A weighted-means value of SRR, FSH, T, and TV was created, and a weighted linear regression was then used to describe associations among SRR, type of procedure, FSH, T, and TV. In this study, weighted-means values demonstrated mTESE to be superior to cTESE with an SRR of 51.9% vs 40.1%. Multiple weighted linear regressions were created to describe associations among SRR, procedure type, FSH, T, and TV. The models showed that for every 1.19 mIU ml-1 increase in FSH, there would be a significant decrease in SRR by 1.0%. Seeking to create a more clinically relevant model, FSH values were then divided into normal, moderate elevation, and significant elevation categories (FSH <10 mIU ml-1, 10-19 mIU ml-1, and >20 mIU ml-1, respectively). For an index patient undergoing cTESE, the retrieval rates would be 57.1%, 44.3%, and 31.2% for values normal, moderately elevated, and significantly elevated, respectively. In conclusion, in a large meta-analysis, mTESE was shown to be more successful than cTESE for sperm retrievals. FSH has an inverse relationship to SRR in retrieval techniques and can alone be predictive of cTESE SRR.
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Affiliation(s)
- Nicholas Major
- Department of Urology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - K Russ Edwards
- Department of Urology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kit Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Marc Rogers
- Department of Urology, University of North Carolina, Chapel Hill, NC 27514, USA
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Baeck JH, Kim TJ, Kim TH, Lee SR, Park DS, Kwon H, Shin JE, Lee DH, Yu YD. A dual-center study of predictive factors for sperm retrieval through microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in men with non-mosaic Klinefelter syndrome. Investig Clin Urol 2023; 64:41-50. [PMID: 36629064 PMCID: PMC9834573 DOI: 10.4111/icu.20220253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/11/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study evaluated the predictors of sperm retrieval (SR) in non-mosaic Klinefelter syndrome (KS) patients undergoing microsurgical testicular sperm extraction (mTESE). The cutoff values of the predictors of SR and overall pregnancy rates after intracytoplasmic sperm injection (ICSI) were analyzed for the positive SR (PSR) cases. MATERIALS AND METHODS The study was a dual-center retrospective study. Overall 118 patients with KS underwent mTESE between January 2011 and July 2021. Clinicopathological factors including comorbidities, endocrine profiles, and testicular volumes were analyzed. RESULTS A total of 58 patients showed PSR (49.2%) and 60 patients (50.8%) had negative SR (NSR). The mean overall age of the patients was 32.5 years. The NSR patients had a significantly greater prevalence of obesity, diabetes mellitus, and cerebrovascular disease. The PSR group had a significantly higher left testis mean volume (p=0.039). The differences between the two study groups regarding follicular-stimulating hormone, luteinizing hormone, and testosterone variations at 1 and 3 months after mTESE were insignificant. Preoperative mean neutrophil-to-lymphocyte ratio was significantly greater in the NSR group (p=0.011), but the platelet-to-lymphocyte ratio showed no significant difference between the two study groups. A live child birth was achieved in 53.4% of the PSR patients. Multivariate logistic analysis showed that total testicular volume >3.93 mL, left testis volume >1.79 mL, and neutrophil-to-lymphocyte ratio ≤1.82 were significantly associated with PSR. CONCLUSIONS mTESE-ICSI is a feasible method for KS patients to have a child, and total testicular volume, left testis volume, and neutrophil-to-lymphocyte ratio might be predictors of successful SR.
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Affiliation(s)
- Jong Hyeun Baeck
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Tae Jin Kim
- Department of Urology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Tae Heon Kim
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung-Ryeol Lee
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Bundang Medical Center, Seongnam, Korea
| | - Ji Eun Shin
- Department of Obstetrics and Gynecology, Fertility Center of CHA Bundang Medical Center, Seongnam, Korea
| | - Dong Hyeon Lee
- Department of Physiology, CHA University School of Medicine, Seongnam, Korea
| | - Young Dong Yu
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Boeri L, Bebi C, Dente D, Greco E, Turetti M, Capece M, Cocci A, Cito G, Preto M, Pescatori E, Ciampaglia W, Scroppo FI, Falcone M, Ceruti C, Gadda F, Franco G, Dehò F, Palmieri A, Rolle L, Gontero P, Montorsi F, Montanari E, Salonia A. Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed classic TESE: results from a multicenter cross-sectional study. Int J Impot Res 2022; 34:795-799. [PMID: 34743195 DOI: 10.1038/s41443-021-00487-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022]
Abstract
Microdissection testicular sperm extraction (mTESE) has been proposed as a salvage treatment option for men with a previously failed classic TESE (cTESE), but data are scarce. We aimed to assess the outcome of and potential predictors of successful salvage mTESE in a cohort of men previously submitted to unfruitful cTESE. Data from 61 men who underwent mTESE after a failed cTESE between 01/2014 and 10/2020, at 6 tertiary-referral centres in Italy were analysed. All men were investigated with semen analyses, testicular ultrasound, hormonal and genetic blood testing. Pathological diagnosis from TESE was collected in every man. Descriptive statistics and logistic regression models were used to investigate potential predictors of positive sperm retrieval (SR+) after salvage mTESE. Baseline serum Follicle-Stimulating hormone (FSH) and total testosterone levels were 17.2 (8.6-30.1) mUI/mL and 4.7 (3.5-6.4) ng/mL, respectively. Sertoli-cell-only syndrome (SCOS), maturation arrest (MA) and hypospermatogenesis were found in 24 (39.3%), 21 (34.4%) and 16 (26.2%) men after cTESE, respectively. At mTESE, SR+ was found in 30 (49.2%) men. Patients with a diagnosis of hypospermatogenesis had a higher rate of SR+ (12/16 (75%)) compared to MA (12/21 (57.1%)) and SCOS (6/24 (25%)) patients at mTESE (p < 0.01). No clinical and laboratory differences were observed between SR+ and SR- patients at mTESE. There were no significant complications after mTESE. At multivariable logistic regression analysis, only hypospermatogenesis (OR 9.5; p < 0.01) was independently associated with SR+ at mTESE, after accounting for age and FSH.In conclusion, salvage mTESE in NOA men with previous negative cTESE was safe and promoted SR+ in almost 50%. A baseline pathology of hypospermatogenesis at cTESE emerged as the only independent predictor of positive outcomes at salvage mTESE.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Donato Dente
- Unit of Robotic & Mininvasive Surgery - Casa Di Cura Villa Igea, Ancona, Italy
| | - Ermanno Greco
- Centre for Reproductive Medicine, European Hospital, Rome, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Andrea Cocci
- Department of Urology and Andrology Surgery, University of Florence, Florence, Italy
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, University of Florence, Florence, Italy
| | - Mirko Preto
- Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Edoardo Pescatori
- Reproductive Medicine Unit, GynePro Medical Centers, NextClinics International, Bologna, Italy
| | - Walter Ciampaglia
- Reproductive Medicine Unit, GynePro Medical Centers, NextClinics International, Bologna, Italy
| | | | - Marco Falcone
- Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Carlo Ceruti
- Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giorgio Franco
- Department Gynaecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Dehò
- Department of Urology and Andrology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Luigi Rolle
- Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Paolo Gontero
- Division of Urology, A.O.U. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
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Non-invasive Molecular Biomarkers for Predicting Outcomes of Micro-TESE in Patients with Idiopathic Non-obstructive Azoospermia. Expert Rev Mol Med 2022; 24:e22. [PMID: 35659383 DOI: 10.1017/erm.2022.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Lira FNT. Hormonal treatment for men with Non-obstructive Azoospermia: too many rationales, too little data. Int Braz J Urol 2022; 48:482-484. [PMID: 35373946 PMCID: PMC9060158 DOI: 10.1590/s1677-5538.ibju.2022.99.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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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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12
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Caroppo E, Colpi GM. Prediction Models for Successful Sperm Retrieval in Patients with Non-Obstructive Azoospermia Undergoing Microdissection Testicular Sperm Extraction: Is There Any Room for Further Studies? J Clin Med 2021; 10:jcm10235538. [PMID: 34884245 PMCID: PMC8658396 DOI: 10.3390/jcm10235538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 01/24/2023] Open
Abstract
Several prediction models for successful sperm retrieval (SSR) in patients with azoospermia due to spermatogenic dysfunction (also termed non-obstructive azoospermia—NOA) have been developed and published in the past years, however their resulting prediction accuracy has never been strong enough to translate their results in the clinical practice. This notwithstanding, the number of prediction models being proposed in this field is growing. We have reviewed the available evidence and found that, although patients with complete AZFc deletion or a history of cryptorchidism may have better probability of SSR compared to those with idiopathic NOA, no clinical or laboratory marker is able to determine whether a patient with NOA should or should not undergo microdissection testicular sperm extraction (mTESE) to have his testicular sperm retrieved. Further research is warranted to confirm the utility of evaluating the expression of noncoding RNAs in the seminal plasma, to individuate patients with NOA with higher probability of SSR.
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Affiliation(s)
- Ettore Caroppo
- Andrology Outpatients Clinic, Asl Bari, PTA “F Jaia”, Conversano, 70014 Bari, Italy
- Correspondence:
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13
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Kavoussi PK, Hudson K, Machen GL, Barsky M, Lebovic DI, Kavoussi SK. FSH levels and testicular volumes are associated with the severity of testicular histopathology in men with non-obstructive azoospermia. J Assist Reprod Genet 2021; 38:3015-3018. [PMID: 34532836 PMCID: PMC8608933 DOI: 10.1007/s10815-021-02313-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study is to assess a potential association between FSH levels and testicular volumes with the severity of testicular histopathology on testicular biopsy in men with non-obstructive azoospermia (NOA) undergoing microdissection testicular sperm extraction (microTESE). Methods A retrospective chart review was performed from the electronic health records of men who underwent microTESE with NOA. Results Eighty-six men with NOA underwent microTESE with concomitant testicular biopsy for permanent section to assess the testicular cellular architecture. The histopathological patterns were categorized by severity indicating the odds of sperm retrieval into 2 categories. The unfavorable category included Sertoli cell only pattern and early maturation arrest (n = 50) and the favorable category included late maturation arrest and hypospermatogenesis patterns (n = 36). In the men with unfavorable histopathologic patterns, the mean FSH level was 22.9 ± 16.6 IU/L, and the mean testicular volume was 10.4 ± 6.0 cc. This was in comparison to men with favorable histopathologic patterns revealing a mean FSH level of FSH 13.3 ± 12.0 with a mean testicular volume of 13.3 ± 5.9 cc. There was a statistically significant higher FSH level in men with unfavorable histopathology than favorable (p = 0.004) as well as a significant smaller mean testicular volume in men with unfavorable histopathology (p = 0.029). Conclusions Higher serum FSH levels and smaller testicular volumes are associated with more severe testicular histopathological patterns in men with NOA.
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Affiliation(s)
- Parviz K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA.
| | - Kayla Hudson
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA
| | - G Luke Machen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA
| | - Maya Barsky
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA
| | - Dan I Lebovic
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA
| | - Shahryar K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX, 78746, USA
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14
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Caroppo E, Castiglioni F, Campagna C, Colpi EM, Piatti E, Gazzano G, Colpi GM. Intrasurgical parameters associated with successful sperm retrieval in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction. Andrology 2021; 9:1864-1871. [PMID: 34289247 DOI: 10.1111/andr.13082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with non-obstructive azoospermia with a previously failed conventional testicular sperm extraction may undergo a salvage microdissection testicular sperm extraction with the probability of successful sperm retrieval being almost dependent upon the number of previous surgical attempts and to different histopathologic categories. OBJECTIVES To determine whether the seminiferous tubules pattern and the histological categories could affect the sperm retrieval rate in patients with non-obstructive azoospermia undergoing salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction. MATERIALS AND METHODS Seventy-nine patients undergoing unilateral or bilateral salvage microdissection testicular sperm extraction were evaluated. During microdissection testicular sperm extraction, if present, dilated tubules were retrieved, otherwise, tubules with slightly larger caliber than that of the surroundings were removed. When no dilated tubule or tubule with slightly larger caliber was found, not dilated tubules were excised. A prediction model was built with seminiferous tubules pattern and testis histology as covariates. RESULTS Sperm retrieval was successful in 30 out of 79 patients. The prediction model correctly classified 88.3% of cases, explained the 29.7% variability of the outcome, and significantly predicted the microdissection testicular sperm extraction outcome with a sensitivity of 67.7% and a specificity of 90.2%, Both tubules with slightly larger caliber and not dilated tubules were negatively associated with the chance of retrieving spermatozoa. Among the histological categories, only early maturation arrest was significant to the model (log(SSR) = 0.57 - 1.9SDT - 3.3NDT - 1.76EMA) (where SSR is sperm retrieval rate, SDT is tubule with slightly larger caliber, NDT is not dilated tubule, and EMA is early maturation arrest). The model had a clearly useful discrimination (area under the curve = 0.814), the estimated performance was 0.8105, and internal calibration was acceptable (p > 0.05). DISCUSSION Seminiferous tubules pattern and testis histology may reliably explain the salvage microdissection testicular sperm extraction outcome in all patients with non-obstructive azoospermia apart from those with early maturation arrest, where the homogeneous apparent seminiferous tubules pattern may be misleading. CONCLUSION The outcome of salvage microdissection testicular sperm extraction can be predicted by the same intrasurgical parameters that have been demonstrated to predict the outcome of microdissection testicular sperm extraction in naïve patients with non-obstructive azoospermia.
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Affiliation(s)
- Ettore Caroppo
- Asl Bari, PTA F Jaia, Andrology Outpatient Clinic, Bari, Italy
| | | | | | | | | | - Giacomo Gazzano
- Division of Anatomic Pathology, Istituto Auxologico Italiano (IRCCS), Milano, Italy
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Analysis of STAG3 variants in Chinese non-obstructive azoospermia patients with germ cell maturation arrest. Sci Rep 2021; 11:10077. [PMID: 33980954 PMCID: PMC8115624 DOI: 10.1038/s41598-021-89559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
STAG3 is essential for male meiosis and testis of male Stag3-/- mice shows the histopathological type of germ cell maturation arrest (MA). Whether variants of the STAG3 gene exist in Chinese idiopathic non-obstructive azoospermia (NOA) patients needs to be determined. We recruited 58 Chinese NOA men with MA who underwent testis biopsy and 192 fertile men as the control group. The 34 exons of the STAG3 gene were amplified using polymerase chain reaction (PCR) and sequenced. We identified eight novel single nucleotide polymorphisms (SNPs), including two missense SNPs (c.433T > C in exon2 and c.553A > G in exon3), three synonymous SNPs (c.539G > A, c.569C > T in exon3, and c.1176C > G in exon8), and three SNPs in introns. The allele and genotype frequencies of the novel and other SNPs have no significant differences between two groups. Our results indicated that variants in the coding sequence of the STAG3 gene were uncommon in NOA patients with MA in Chinese population. Future studies in large cohorts of different ethnic populations will be needed to determine the association between the STAG3 gene and NOA.
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Ernandez J, Berk B, Han T, Abou Ghayda R, Kathrins M. Evaluating the quality of reported outcomes for microsurgical TESE in men with non-obstructive azoospermia: A methodological analysis. Andrology 2021; 9:1108-1118. [PMID: 33675583 DOI: 10.1111/andr.12997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Publications of microsurgical testicular sperm extraction (mTESE) techniques and outcomes are heterogeneous, which may limit creation of best surgical practices. OBJECTIVE To study the quality and heterogeneity of published mTESE outcomes via a methodological analysis. MATERIALS/METHODS A systematic methodological analysis of all published literature on the use of mTESE in men with non-obstructive azoospermia from 1999 to the July 2020 was performed. PubMed and MEDLINE searches were performed using the search terms "microdissection TESE OR microsurgical TESE." Publications were evaluated on their reporting of pre-operative factors, intraoperative techniques, surgical and clinical outcomes, and adverse events. RESULTS Fifty-five studies met inclusion criteria. Surgical technique and sperm retrieval rates were the most reported criteria. Reporting on the presence of an embryologist intraoperatively was observed in approximately 30% of articles, while other procedural details including method of sperm quantification, quantity retrieved, and number of cryopreserved vials were observed in fewer than 10% of articles. Clinical outcomes, including pregnancy rates and live birth rates, were reported in fewer than 40% of the articles. Fetal outcomes including fetal and neonatal anomalies were rarely reported. Fetal growth restriction, preterm delivery, small or large for gestational age, and NICU admissions were never reported. CONCLUSION There are inconsistencies in reporting quality of mTESE outcomes, specifically a lack of information on the quantity and quality of sperm retrieved, the role of embryology intraoperatively, and clinical outcomes, such as live birth rate and fetal anomalies. These gaps may guide development of standardized reporting guidelines to better assess and compare clinical outcomes across institutions and maintain focus on couples-centric fertility outcomes in future mTESE studies.
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Affiliation(s)
| | - Brittany Berk
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tracy Han
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramy Abou Ghayda
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Martin Kathrins
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
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Majzoub A, Arafa M, Khalafalla K, AlSaid S, Burjaq H, Albader M, Al-Marzooqi T, Esteves SC, Elbardisi H. Predictive model to estimate the chances of successful sperm retrieval by testicular sperm aspiration in patients with nonobstructive azoospermia. Fertil Steril 2020; 115:373-381. [PMID: 33059887 DOI: 10.1016/j.fertnstert.2020.08.1397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore predictors of successful sperm retrieval (SR) and to identify potentially suitable candidates for testicular sperm aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. DESIGN Retrospective chart review. SETTING Academic tertiary medical center. PATIENTS A total of 297 patients with nonobstructive azoospermia. INTERVENTIONS All patients underwent full clinical evaluation before undergoing a staged SR procedure, starting with TESA and proceeding to microsurgical testicular sperm extraction (microTESE). Predictors of positive SR with TESA were selected using the least absolute shrinkage and selection operator (LASSO) regression analysis using k-fold cross-validation. The obtained regression coefficients were used to create a predictive model, and a receiver operating characteristic (ROC) curve was obtained to express its predictive ability. Cut-off values for each significant predictor were also identified using ROC analysis. MAIN OUTCOME MEASURE(S) Development of a prediction model for positive SR with TESA. RESULTS Overall, a positive SR was observed in 23.6% of patients undergoing TESA. Average testis size (P = .017) and serum follicle-stimulating hormone (FSH) level (P < .001) were the significant predictors of positive SR identified by LASSO regression analysis. The predictive model had an AUC of 0.742 with a sensitivity of 73.9% and specificity of 69.9%. Patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L had a TESA-positive SR of 43%. CONCLUSIONS TESA may be a suitable alternative to microTESE in selected nonobstructive azoospermia patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L.
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Affiliation(s)
- Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; Andrology Department, Cairo University, Cairo, Egypt
| | | | - Sami AlSaid
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hasan Burjaq
- Assisted Conception Unit, Hamad Medical Corporation, Doha, Qatar
| | - Moza Albader
- Assisted Conception Unit, Hamad Medical Corporation, Doha, Qatar
| | | | - Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil; Faculty of Health, Department of Clinical Sciences, Aarhus University, Aarhus, Denmark
| | - Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
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Çayan S, Orhan İ, Altay B, Aşcı R, Akbay E, Ayas B, Yaman Ö. Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction. Andrology 2020; 9:253-259. [PMID: 32960506 DOI: 10.1111/andr.12910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/07/2020] [Accepted: 09/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. OBJECTIVES To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). MATERIALS AND METHODS This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. RESULTS Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle-stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. CONCLUSIONS Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.
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Affiliation(s)
- Selahittin Çayan
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - İrfan Orhan
- Fırat University School of Medicine, Elazığ, Turkey
| | - Barış Altay
- Ege University School of Medicine, İzmir, Turkey
| | - Ramazan Aşcı
- Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Erdem Akbay
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - Bülent Ayas
- Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Önder Yaman
- Ankara University School of Medicine, Ankara, Turkey
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Kavoussi PK, West BT, Chen SH, Hunn C, Gilkey MS, Machen GL, Kavoussi KM, Esqueda A, Wininger JD, Kavoussi SK. A comprehensive assessment of predictors of fertility outcomes in men with non-obstructive azoospermia undergoing microdissection testicular sperm extraction. Reprod Biol Endocrinol 2020; 18:90. [PMID: 32847601 PMCID: PMC7448981 DOI: 10.1186/s12958-020-00646-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microdissection testicular sperm extraction (microTESE) in men with non-obstructive azoospermia (NOA) is the procedure that results in the highest number of sperm cells retrieved for in vitro fertilization (IVF). This study presents a novel assessment of predictors of sperm retrieval as well as downstream embryology and pregnancy outcomes in cases of men with NOA undergoing microTESE. METHODS A retrospective chart review of 72 men who underwent microTESE for predictors of fertility outcomes including sperm retrieved at microTESE, embryology progression to embryo transfer (ET), clinical pregnancy, live birth, and surplus sperm retrieved for additional IVF/intracytoplasmic injection cycles beyond one initial cycle. Statistical models for each of these outcomes were fitted, with a p-value of < 0.05 considered significant for the parameters estimated in each model. RESULTS Seventy-two men underwent microTESE, and 51/72 (70.8%) had sperm retrieved. Of those, 29/43 (67.4%) reached ET. Of the couples who underwent ET, 21/29 (72.4%) achieved pregnancy and 18/29 (62.1%) resulted in live birth. Of the men with sperm retrieved, 38/51 (74.5%) had surplus sperm cryopreserved beyond the initial IVF cycle. Age, testicular volume, FSH, and testicular histopathology were assessed as predictors for sperm retrieved at microTESE, progression to ET, pregnancy, live birth, and surplus sperm. There were no preoperative predictors of sperm retrieval, clinical pregnancy, or live birth. Age predicted reaching ET, with older men having increased odds. FSH level had a negative relationship with surplus sperm retrieved. Men with hypospermatogenesis histology had higher rates of sperm retrieval, clinical pregnancy, live birth, and having surplus sperm. CONCLUSIONS Men who underwent microTESE with a hypospermatogenesis histopathology had better outcomes, including higher rates of sperm retrieval, clinical pregnancy, live birth, and having surplus sperm retrieved. Increasing male partner age increased the odds of reaching ET. No other clinical factors were predictive for the outcomes considered.
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Affiliation(s)
- Parviz K. Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Brady T. West
- grid.214458.e0000000086837370Institute for Social Research, University of Michigan, Ann Arbor, MI 48109 USA
| | - Shu-Hung Chen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Caitlin Hunn
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Melissa S. Gilkey
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - G. Luke Machen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Keikhosrow M. Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Amy Esqueda
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - J. David Wininger
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
| | - Shahryar K. Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746 USA
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Abu MA, Tajuddin SA, Abdul Karim AK, Ahmad MF, Mohd Razi ZR, Omar MH. Predictor for unfavorable Johnsen scoring in non-obstructive azoospermia before intra cytoplasmic sperm insemination and its outcome. ACTA ACUST UNITED AC 2020; 72:351-354. [PMID: 32720800 DOI: 10.23736/s0026-4784.20.04573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Muhammad A Abu
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia -
| | - Siti A Tajuddin
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia
| | - Abdul K Abdul Karim
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia
| | - Mohd F Ahmad
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia
| | - Zainul R Mohd Razi
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia
| | - Mohd H Omar
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malesia
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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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Li F, Yang Q, Shi H, Xin H, Luo X, Sun Y. Effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in men with nonobstructive azoospermia undergoing testicular sperm aspiration-intracytoplasmic sperm injection cycles. Andrologia 2019; 51:e13265. [PMID: 30854691 DOI: 10.1111/and.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 12/15/2022] Open
Abstract
The objective of this study was to assess the effects of body mass index (BMI) on sperm retrieval, early embryo quality and clinical outcomes in patients with nonobstructive azoospermia (NOA) undergoing testicular sperm aspiration-intracytoplasmic sperm injection (TESA-ICSI). A total of 3,005 infertile couples were evaluated between January 2010 and June 2017, including 1585 normal-weight (BMI < 25 kg/m2 ), 847 overweight (BMI 25-29.99 kg/m2 ) and 573 obese (BMI ≥ 30 kg/m2 ) patients. We found no significant relationship between BMI and sperm retrieval rate (22.4%, 24.3% and 25.1%, p = 0.327) or sperm motility. Among the 705 patients with NOA who underwent TESA-ICSI cycles, obese individuals had lower T levels and higher E2 levels than normal-weight and overweight individuals. However, there were no significant differences in other male hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], or prolactin [PRL]) among the groups. We also found that the sperm parameters, embryo quality and clinical outcomes of patients with NOA undergoing TESA-ICSI were not influenced by high BMI levels. In conclusion, this study demonstrated a lack of obvious effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in infertile men undergoing TESA-ICSI cycles, although T and E2 levels were affected.
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Affiliation(s)
- Fangyuan Li
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingling Yang
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hang Xin
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Luo
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Reproductive Medical Center and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kızılay F, Semerci B, Şimşir A, Kalemci S, Altay B. Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men. Turk J Urol 2019; 45:S1-S6. [PMID: 30817282 DOI: 10.5152/tud.2019.76009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. MATERIAL AND METHODS A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. The sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. RESULTS Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). CONCLUSION Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.
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Affiliation(s)
- Fuat Kızılay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Semerci
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Adnan Şimşir
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Serdar Kalemci
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Barış Altay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
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Gnessi L, Scarselli F, Minasi MG, Mariani S, Lubrano C, Basciani S, Greco PF, Watanabe M, Franco G, Farcomeni A, Greco E. Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC Urol 2018; 18:63. [PMID: 29973189 PMCID: PMC6032772 DOI: 10.1186/s12894-018-0379-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background To provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE. The aim of our study was to determine the impact of different parameters, including testicular histopathology, on sperm retrieval in case of reoperation in patients undergoing testicular sperm extraction. Methods We retrospectively analyzed 486 patients who underwent sperm extraction for intracytoplasmic sperm injection and testicular biopsy. Histology was classified into: normal spermatogenesis; hypospermatogenesis (reduction in the number of normal spermatogenetic cells); maturation arrest (absence of the later stages of spermatogenesis); and Sertoli cell only (absence of germ cells). Semen analysis and serum FSH, LH and testosterone were measured. Results Four hundred thirty patients had non obstructive azoospermia, 53 severe oligozoospermia and 3 necrozoospermia. There were 307 (63%) successful sperm retrieval. Higher testicular volume, lower levels of FSH, and better histological features were predictive for sperm retrieval. The same parameters and younger age were predictive factors for shorter time for sperm recovery. After multivariable analysis, younger age, better semen parameters, better histological features and lower values of FSH remained predictive for shorter time for sperm retrieval while better semen and histology remained predictive factors for successful sperm retrieval. The predictive capacity of a score obtained by summing the points assigned for selected predictors (1 point for Sertoli cell only, 0.33 points for azoospermia, 0.004 points for each FSH mIU/ml) gave an area under the ROC curve of 0.843. Conclusions This model can help the practitioner with counseling infertile men by reliably predicting the chance of obtaining spermatozoa with testicular sperm extraction when a repeat attempt is planned.
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Affiliation(s)
- Lucio Gnessi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy.
| | | | | | - Stefania Mariani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - Sabrina Basciani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | | | - Mikiko Watanabe
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - Giorgio Franco
- Department Gynaecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Ermanno Greco
- Centre for Reproductive Medicine, European Hospital, Rome, Italy
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Liu W, Gao X, Yan L, Liu H, Yu R, Zhao S, Ma J. Analysis of CDK2 mutations in Chinese men with non-obstructive azoospermia who underwent testis biopsy. Reprod Biomed Online 2018; 36:356-360. [PMID: 29373224 DOI: 10.1016/j.rbmo.2017.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/30/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
To examine whether mutations of the CDK2 gene exist in Chinese men with non-obstructive azoospermia (NOA) with different histopathology, we recruited 175 Chinese men with idiopathic NOA who underwent testis biopsy, including hypospermatogenesis, germ cell maturation arrest and Sertoli cell only syndrome. Genomic DNA was extracted from peripheral blood samples. Subsequently, the seven exons of the CDK2 gene were amplified using polymerase chain reaction with specific primers, respectively. The polymerase chain reaction products were sequenced on an automated sequencer. We identified four known single nucleotide polymorphisms: c.324G>A in exon 1; c.363T>C in exon 2; c.*570G>A; and c.*1160G>C in the 3' UTR of the CDK2 gene. Comparison of the genotype and allele frequencies showed no significant differences between NOA cases and controls for the four single nucleotide polymorphisms. Furthermore, no significant differences were found between each pathological group and control group, respectively. The results indicate that mutations in the coding sequence of the CDK2 gene may not be responsible for idiopathic NOA in Chinese men. Future studies in large cohorts of different ethnic populations are warranted to establish whether associations exist between the CDK2 gene and NOA.
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Affiliation(s)
- Wen Liu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China
| | - Xuan Gao
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China
| | - Hongli Liu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China
| | - Ruimei Yu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China
| | - Shidou Zhao
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China.
| | - Jinlong Ma
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, 157 Jingliu Road, Jinan, 250021, China; The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250021, China.
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Okuyama N, Obata R, Oka N, Nakamura Y, Hattori H, Nakajo Y, Aono N, Koizumi M, Toya M, Nagao K, Tai T, Hashimoto T, Igarashi H, Kyono K. Long-term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men. Reprod Med Biol 2017; 17:82-88. [PMID: 29371826 PMCID: PMC5768980 DOI: 10.1002/rmb2.12073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 10/21/2017] [Indexed: 01/09/2023] Open
Abstract
Purpose To find the best methods to achieve the highest pregnancy and birth rates for couples needing testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI). Methods Retrospectively studied were 801 patients with male factor infertility who had undergone TESE‐ICSI between April, 1996 and July, 2016 and who had been categorized into four groups: obstructive azoospermia (OA); non‐obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). The sperm retrieval rate, hormone levels, fertilization rate (FR), pregnancy rate (PR), and birth rate (BR) after ICSI among three groups were compared: fresh testicular sperm (FS)‐fresh oocytes (FO) (Group I); frozen‐thawed testicular sperm‐FO (Group II); and FS‐vitrified‐warmed oocytes (Group III). Results The testicular sperm recovery rate was 57.8% (463/801): 89.6% in the Crypt, 97.1% in the OA, 28.9% in the NOA, and 42.2% in the KS groups. The follicle‐stimulating hormone levels were significantly higher in the NOA and KS groups and the testosterone levels were significantly lower in the KS group. The FR, PR, and BR were: 65.2%, 43.2%, and 28.5% in group I; 59.2%, 33.4%, and 18.7% in group II; and 56.4%, 33.8%, and 22.1% in group III. Conclusion Intracytoplasmic sperm injection with FS‐FO achieved the best PR and BR. It should be considered what to do in cases with no testicular sperm by TESE. The authors hope that ICSI with donor sperm will be allowed in Japan in the near future.
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Affiliation(s)
| | | | - Nao Oka
- Kyono ART Clinic Takanawa Tokyo Japan
| | | | | | | | - Nobuya Aono
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART Clinic Sendai Japan
| | | | | | - Koichi Nagao
- First Department of Urology Toho University School of Medicine Tokyo Japan
| | - Toshihiro Tai
- First Department of Urology Toho University School of Medicine Tokyo Japan
| | | | | | - Koichi Kyono
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART Clinic Sendai Japan
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