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Sakas J, Radin O, Abrahami N, Altshuler O, Younis JS. Testicular fine-needle aspiration in infertile men with absolute non-obstructive azoospermia: A single-centre cohort study. Aust N Z J Obstet Gynaecol 2024; 64:258-263. [PMID: 38078572 DOI: 10.1111/ajo.13783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/19/2023] [Indexed: 07/16/2024]
Abstract
BACKGROUND The methodology of surgically extracted sperm cells in fertility treatments remains debated, mainly due to the lack of data evaluating its predictive value on treatment outcomes. AIM To gain insight into the effectiveness of testicular fine-needle aspiration (TEFNA) in a cohort of infertile men with absolute non-obstructive azoospermia and to examine whether the number of retrieved sperm cells affects the fertilisation rate. MATERIALS AND METHODS A total of 89 infertile men, aged 26-47, meticulously diagnosed with non-obstructive azoospermia, participated in the study. All participants underwent TEFNA. The primary outcome measure was the TEFNA success rate in retrieving mature sperm. The secondary outcome measures included fertilisation rate, clinical pregnancy rates, and live births associated with the retrieved sperm. RESULTS Sperm cells were successfully retrieved from 40 out of 89 patients (45%) with no significant postoperative complications. Retrieval of up to ten sperm cells occurred in 11 procedures (25%); ten procedures (22.7%) resulted in producing dozens of sperm cells, and 100s to 1000s of sperm cells were obtained from the remainder of 23 procedures (52.3%). Patients whose TEFNA resulted in only a few sperm cells had a much lower fertilisation rate (16.6%) than the other two groups (40.1% and 47.2%, respectively, P = 0.003). CONCLUSIONS The utilisation of TEFNA for sperm extraction in men with non-obstructive azoospermia is a simple, fast-learning, effective, and safe treatment option. In cases where sperm retrieval was successful, the fertilisation rate was strongly related to the number of sperm cells obtained.
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Affiliation(s)
- Jawad Sakas
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Israel
| | - Orit Radin
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Israel
| | - Noa Abrahami
- Department of Anesthesiology, Galilee Medical Center, Nahariya, Israel
| | - Osnat Altshuler
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Israel
| | - Johnny S Younis
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
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Yau M, Malhotra NR, Steever J, Baldisserotto E, Lin C, Fader R, Oransky M, Safer JD. Pubertal Status at the Time of Fertility Preservation in Transgender Girls. Endocr Pract 2024; 30:356-359. [PMID: 38242354 DOI: 10.1016/j.eprac.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Puberty blockade and gender-affirming hormone therapy can impair fertility. Counseling on fertility preservation is important before initiation of therapy. Our study aimed to assess Tanner staging and the presence of virilizing secondary sex characteristics at the time of sperm collection and correlate the viability of sperm with the Tanner staging and degree of virilization. METHODS A retrospective chart review of 23 transgender girls referred to pediatric urology at our academic pediatric transgender clinic for fertility preservation counseling was performed. At the initial visit before treatment, pubertal staging along with the assessment of virilizing secondary characteristics was performed. The semen analyses were evaluated for volume, sperm concentration, total sperm count, motility, and total motile count. RESULTS Of the first 23 transgender girls evaluated and counseled, 8 transgender females successfully produced a sperm sample for cryopreservation. The average testicular volume was 18.5 ml and ranged from 12 ml to 20 ml. The median semen parameters were at or above the 2021 World Health Organization threshold. The 8 transgender females who successfully underwent fertility preservation presented with at least 1 secondary sex characteristic. In 1 subject with Tanner stage 3 pubic hair development and a testicular volume of 12 ml, only voice change was reported. Facial hair and laryngeal prominence were not present on examination. CONCLUSION More than a third of our patients who accepted a referral to pediatric urology agreed to produce a sperm sample for cryopreservation. All of these patients successfully preserved sperm. With counseling and early referral to pediatric urology, a high percentage of fertility preservation in transgender girls was achieved.
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Affiliation(s)
- Mabel Yau
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York; Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, New York.
| | - Neha R Malhotra
- Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York
| | - John Steever
- Division of Adolescent Medicine, Mount Sinai Kravis Children's Hospital, New York, New York
| | - Eva Baldisserotto
- Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York
| | - Cathy Lin
- Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, New York
| | - Ralph Fader
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York; Department of Psychiatry, Mount Sinai Hospital, New York, New York
| | - Matthew Oransky
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York; Division of Endocrinology, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
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Deng C, Mao J, Zhao L, Liu D, Lin H, Zhang Z, Yang Y, Zhang H, Hong K, Jiang H. Testicular sperm aspiration has a poor effect in predicting micro-TESE outcomes in NOA patients with AZFc deletion. Basic Clin Androl 2023; 33:28. [PMID: 37558984 PMCID: PMC10413523 DOI: 10.1186/s12610-023-00195-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Testicular sperm aspiration (TESA) is widely used in the diagnosis and management of nonobstructive azoospermia. However, its ability for predicting microdissection testicular sperm extraction in nonobstructive azoospermia (NOA) patients with AZFc deletion remains uncertain. To investigate whether TESA affected the sperm retrieval rate (SRR) in NOA patients with AZFc deletion, a retrospective analysis of the clinical data of NOA patients with AZFc deletion who underwent microdissection testicular sperm extraction (micro-TESE) was conducted. The effects of age, testicular volume, follicle-stimulating hormone (FSH) levels, luteinizing hormone (LH) levels, testosterone (T) levels and TESA on the SRR were analyzed in this group of patients. RESULTS A total of 181 individuals had their sperm successfully collected and underwent micro-TESE, with an SRR of 67.4%. The patients were separated into two groups based on their micro-TESE results (sperm acquisition and nonsperm acquisition), with no significant variations in age, testicular volume, FSH levels, LH levels, or T levels between the two groups. There was no significant difference in the SRR between any of the groups into which patients were classified based on reproductive hormone reference value ranges. Binary logistic regression was used to explore the absence of significant effects of age, testicular volume, FSH levels, LH levels, and T levels on sperm acquisition in patients undergoing micro-TESE. In the preoperative testicular diagnostic biopsy group, the sperm acquisition and nonsperm acquisition groups had SRRs of 90.1% and 65.1%, respectively. More significantly, there was no significant difference in the SRR between the negative preoperative testicular diagnostic biopsy group and the nonpreoperative testicular diagnostic biopsy group (65.1 vs. 63.8%, p = 0.855). CONCLUSION There is a high probability of successful sperm acquisition in the testis of men undergoing micro-TESE. In this group of patients, age, testicular volume, FSH levels, LH levels, and T levels may have little bearing on the micro-TESE outcome. In patients whose preoperative TESA revealed the absence of sperm, the probability of obtaining sperm by micro-TESE remained high (65.1%); negative TESA results appeared to not influence the SRR (63.8%) in patients undergoing micro-TESE.
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Affiliation(s)
- Chenyao Deng
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
| | - Jiaming Mao
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, 100191, China
| | - Lianming Zhao
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Defeng Liu
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, 100191, China
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Zhe Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
| | - Yuzhuo Yang
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, 100191, China
| | - Haitao Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
| | - Kai Hong
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China.
- Department of Human Sperm Bank, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
- Department of Andrology, Peking University Third Hospital, Beijing, 100191, China.
- Department of Human Sperm Bank, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
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Billa E, Kanakis GA, Goulis DG. Endocrine Follow-Up of Men with Non-Obstructive Azoospermia Following Testicular Sperm Extraction. J Clin Med 2021; 10:jcm10153323. [PMID: 34362107 PMCID: PMC8347935 DOI: 10.3390/jcm10153323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Testicular sperm extraction (TESE) is a surgical procedure which, combined with intracytoplasmic sperm injection, constitutes the main treatment for achieving biological parenthood for patients with infertility due to non-obstructive azoospermia (NOA). Although it is effective, TESE procedures might cause structural testicular damage leading to Leydig cell dysfunction and, consequently, temporary or even permanent hypogonadism with long-term health consequences. To a lesser extent, the same complications have been reported for microdissection TESE, which is considered less invasive. The resulting hypogonadism is more profound and of longer duration in patients with Klinefelter syndrome compared with other NOA causes. Most studies on serum follicle-stimulating hormone and luteinizing hormone concentrations negatively correlate with total testosterone concentrations, which depends on the underlying histology. As hypogonadism is usually temporary, and a watchful waiting approach for about 12 months postoperative is suggested. In cases where replacement therapy with testosterone is indicated, temporary discontinuation of treatment may promote the expected recovery of testosterone secretion and revise the decision for long-term treatment.
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Affiliation(s)
- Evangelia Billa
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
- Correspondence: (E.B.); (G.A.K.)
| | - George A. Kanakis
- IVF Unit, Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, 11521 Athens, Greece
- Correspondence: (E.B.); (G.A.K.)
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
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