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Peri A, Ahler A, Gook D, O'Connell MA, Bourne H, Nightingale M, Telfer M, Jayasinghe Y, Pang KC. Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy. J Assist Reprod Genet 2021; 38:2735-2743. [PMID: 34424432 PMCID: PMC8581091 DOI: 10.1007/s10815-021-02293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Increasing numbers of transgender adolescents are receiving gender-affirming treatments (GAT). Given GAT can impair reproductive function, clinical guidelines advise prior counselling regarding fertility preservation (FP). For transgender adults assigned male at birth, FP is usually achieved via a masturbatory sample and sperm cryopreservation. This is less straightforward in transgender adolescents, since they may not be developmentally ready to masturbate and/or masturbation may cause unacceptable gender dysphoria. Testicular biopsy represents an alternative method for sperm retrieval in these adolescents, but for those in early/mid puberty, it is difficult to predict whether sperm will be found. The purpose of this study was therefore to identify factors that predict successful sperm retrieval for cryopreservation via testicular biopsy. METHODS A retrospective cohort study was undertaken at a tertiary-referral pediatric gender service. Subjects were included if they'd received a testicular biopsy in association with the commencement of GAT between 2010 and 2019. The primary outcome measure was successful sperm retrieval, and potential predictors included age, testicular volume and serum testosterone, LH and FSH levels. RESULTS Of 25 subjects who received a biopsy prior to starting any GAT, 17 had successful sperm retrieval. While age, testosterone, LH and FSH levels showed minimal differences, testicular volume was significantly higher in those with successful sperm retrieval, and a threshold of ≥ 10 mL showed 92% sensitivity and 71% specificity in predicting successful retrieval. An additional 6 patients received a biopsy after starting puberty suppression and before commencement of oestrogen, and one of these individuals had sperm successfully retrieved despite > 2 years of regular puberty suppression. CONCLUSION These findings suggest that testicular volume is most useful in predicting successful sperm retrieval following testicular biopsy in transgender adolescents and are likely to be of relevance to other young people undertaking FP, including those with cancer.
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Affiliation(s)
- Angus Peri
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland
| | - Debra Gook
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
- Reproductive Services/Melbourne IVF, Royal Women's Hospital, Parkville, VIC, Australia
| | - Michele A O'Connell
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Harold Bourne
- Reproductive Services/Melbourne IVF, Royal Women's Hospital, Parkville, VIC, Australia
| | - Michael Nightingale
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michelle Telfer
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Yasmin Jayasinghe
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Ken C Pang
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia.
- Royal Children's Hospital, Melbourne, VIC, Australia.
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
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Aizer A, Lazarovich A, Dratviman-Storobinsky O, Noach-Hirsh M, Haas J, Jacob A, Raviv G, Orvieto R. Cumulative IVF outcomes after retrieval of testicular spermatozoa: should we use immotile spermatozoa for ICSI? Reprod Biomed Online 2021; 43:269-277. [PMID: 34092520 DOI: 10.1016/j.rbmo.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION What are the cumulative clinical pregnancy rates (CPR) and live births rates (LBR) in intracytoplasmic sperm injection (ICSI) cycles using testicular motile compared with immotile spermatozoa, obtained from testicular sperm aspiration (TESA) or extraction (TESE)? DESIGN A retrospective analysis of ICSI cycles using TESA or TESE over a period of 7 years. Cycles were divided into two groups according to the motility of the retrieved spermatozoa: Group A consisted of couples with motile spermatozoa; Group B of couples with immotile spermatozoa. Group B was subdivided into two groups: B1 consisted of couples with motile spermatozoa and B2 with immotile spermatozoa after the addition of pentoxifylline. RESULTS No differences in CPR and LBR per transfer was found between the study groups after fresh embryo transfer. No pregnancies were achieved by vitrified-warmed embryo transfer in group B2. Fertilization rates decreased when using immotile spermatozoa (64.4%, 56%, 37.9%, for groups A, B1 and B2, respectively, P < 0.001). Top-quality embryo rates were higher in groups A and B1 compared with B2 (40.7% and 40.1% versus 19.1%, respectively, P = 0.015). Cumulative CPR (53%, 41.7%, 13.6% for groups A, B1 and B2, respectively, P = 0.005) and LBR (42.4%, 30%, 13.6% for groups A, B1 and B2, respectively P = 0.03) per oocyte retrieval was significantly higher when using motile spermatozoa compared with motile or immotile spermatozoa after adding pentoxifylline. CONCLUSIONS Although fertilization, top-quality embryo rates, cumulative CPR and LBR decreased when using immotile spermatozoa, ICSI is still valid; therefore, it should be considered and offered to couples before embarking on a donor sperm insemination cycle, or cryopreserving oocytes for future additional testicular sperm retrieval.
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Affiliation(s)
- Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan 5621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alon Lazarovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Urology and Andrology Unit, Chaim Sheba Medical Center, Tel Hashomer Ramat Gan, Israel
| | - Olga Dratviman-Storobinsky
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan 5621, Israel
| | - Meirav Noach-Hirsh
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan 5621, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan 5621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Jacob
- The Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Gil Raviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Urology and Andrology Unit, Chaim Sheba Medical Center, Tel Hashomer Ramat Gan, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan 5621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Zhang H, Xi Q, Zhang X, Zhang H, Jiang Y, Liu R, Yu Y. Prediction of microdissection testicular sperm extraction outcome in men with idiopathic nonobstruction azoospermia. Medicine (Baltimore) 2020; 99:e19934. [PMID: 32358364 PMCID: PMC7440282 DOI: 10.1097/md.0000000000019934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of the present study is to assess whether the preoperative clinical indicators have an impact on sperm retrieval rate (SRR) in men with idiopathic nonobstructive azoospermia (NOA).We retrospectively studied 241 consecutive men with NOA who underwent microdissection testicular sperm extraction from 2016 to 2019 in the Reproductive Medicine Center, including 154 patients diagnosed with idiopathic NOA. They were grouped according to preoperative indicators, including average testicular volume, follicle-stimulating hormone (FSH), luteinizing hormone, Testosterone (T), and pathology, respectively.The overall SRR was 20.0% (31/155). Men with testicular volume of ≤5 mL had significant higher SRR than men with testes 5 to 10 and ≥10 mL (35.6% vs 12.3%, P = .002; 35.6% vs 16.2, P = .049, respectively). The SRR in men with FSH ≥ 24.8 mIU/mL was significant higher, compared with FSH level of 12.4 to 24.8 mIU/mL (32.6% vs 15.8%, P = .033). Men with Sertoli cell-only had significantly lower SRR than other pathological type (8.1%). Men with an FSH ≥ 24.8 mIU/mL in testicular volume ≤5 mL group had a significantly higher SRR than FSH level of 12.4 to 24.8 mIU/mL in testicular volume of ≤5 to 10 mL group (44.0% vs 11.4%, P = .002). Men with a luteinizing hormone level of 8.6 to 17.2 mIU/mL in testicular volume of 5 to 10 mL group had a poor prognosis, with an SRR of only 6.5%.Severely reduced testicular volume (≤5 mL) and severely increased FSH level (≥24.8 mIU/mL) had the better sperm retrieval outcome, which can be used as independent predictors in men with idiopathic NOA. And a combination of testicular volume and the hormone seemed to be useful in further increase predictive value.
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Busch AS, Tüttelmann F, Cremers JF, Schubert M, Nordhoff V, Schüring AN, Zitzmann M, Gromoll J, Kliesch S. FSHB -211 G>T Polymorphism as Predictor for TESE Success in Patients With Unexplained Azoospermia. J Clin Endocrinol Metab 2019; 104:2315-2324. [PMID: 30668782 DOI: 10.1210/jc.2018-02249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Testicular sperm extraction (TESE) followed by assisted reproductive techniques often remains the only therapeutic option for men with azoospermia due to spermatogenic failure. Reproductive parameters, such as gonadotropin levels and testicular volume or histopathology, contribute to the prediction of sperm retrieval rate (SRR) in TESE. However, there is an eminent lack of noninvasive predictive factors for TESE outcome. OBJECTIVE To clarify the impact of three common genetic variants affecting FSH and its cognate receptor on testicular histopathology patterns and SRR in TESE. DESIGN We evaluated the association of the single-nucleotide polymorphisms (SNP) FSHB -211G>T (rs10835638), FSHR -29G>A (rs1394205), and FSHR c.2039A>G (rs6166) with testicular histopathology and SRR in patients with azoospermia. SETTING Tertiary referral center for andrology. PATIENTS OR OTHER PARTICIPANTS Men (n = 1075) with azoospermia who underwent TESE (grouped by clinical pathologies). INTERVENTION(S) All participants underwent TESE. MAIN OUTCOME MEASURE(S) Testicular histopathology, SRR, and reproductive hormone levels. RESULTS FSHB -211G>T was significantly associated with reduced chances of sperm retrieval in patients with unexplained azoospermia. Indicating an additional mechanism, the association of the SNP with SSR could not be solely attributed to decreased FSH levels. CONCLUSION A common genetic factor was significantly associated with SRR in TESE. In perspective, a calculator or score including the noninvasive parameters FSH level, testicular volume, and FSHB haplotype should be considered to estimate the chances for sperm retrieval in men with azoospermia.
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Affiliation(s)
- Alexander Siegfried Busch
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
| | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Vesaliusweg, Münster, Germany
| | - Jann-Frederik Cremers
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Maria Schubert
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Verena Nordhoff
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
| | - Andreas N Schüring
- Department of Gynecology and Obstetrics, UKM Fertility Center, University of Münster, Albert-Schweitzer-Campus, Gebäude, Münster, Germany
| | - Michael Zitzmann
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Jörg Gromoll
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
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Shrem G, Brudner Y, Atzmon Y, Michaeli M, Ellenbogen A, Shalom-Paz E. The influence of obesity, smoking, and serum follicular stimulating hormone in azoospermic patients on testicular sperm extraction-intra cytoplasmic sperm injection outcomes: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14048. [PMID: 30681561 PMCID: PMC6358354 DOI: 10.1097/md.0000000000014048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To examine the effect of serum follicle-stimulating hormone (sFSH) level, body-mass index (BMI) and smoking on Testicular Sperm Extraction-Intracytoplasmic Sperm Injection (TESE-ICSI), and pregnancy outcomes.In this retrospective study, data were extracted from files of 52 azoospermic men who underwent TESE and in-vitro fertilization (IVF)-ICSI in our IVF unit. Demographic information, treatment cycle follow-up and pregnancy outcomes were collected.Fifty-two patients underwent 79 TESE due to azoospermia in 143 IVF cycles. Smoking was found to significantly affect sperm motility in TESE specimens before freezing (45.5% vs 14.8%; P <.001); however, this finding did not influence the pregnancy rate. Male FSH was inversely correlated with testicle volume (r = -0.595, P <.0001). Body weight did not affect semen parameters after TESE or ICSI outcomes.Among azoospermic patients with extremely poor sperm quality, male BMI, male FSH or smoking did not have an adverse effect sperm parameters or pregnancy and delivery rates.
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Affiliation(s)
- Guy Shrem
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yana Brudner
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yuval Atzmon
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Mediea Michaeli
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Adrian Ellenbogen
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
| | - Einat Shalom-Paz
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
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Eliveld J, van Wely M, Meißner A, Repping S, van der Veen F, van Pelt AMM. The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Hum Reprod Update 2018; 24:442-454. [PMID: 29726895 PMCID: PMC6016714 DOI: 10.1093/humupd/dmy015] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/27/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation and a decrease in testosterone levels have been described as such. The prevalence and duration of hypogonadism and associated symptoms after TESE have not been studied systematically. OBJECTIVE AND RATIONALE In this systematic review we addressed the following research questions: Are serum testosterone levels decreased after TESE and, if so, do these levels recover over time? What is the prevalence of symptoms and signs related to hypogonadism after TESE and are they related to testosterone levels? SEARCH METHODS We searched the databases Pubmed and Embase from 1 January 1993 to 26 June 2017. We combined subject headings with terms in title and/or abstract for participants, intervention and outcomes. We included all studies that reported on TESE, regardless of the specific technique used, that measured testosterone and/or LH, and/or had information on signs or symptoms related to hypogonadism as defined by hypogonadism guidelines. An additional inclusion criterion was that studies described these measurements both before and after TESE. The quality of the included studies was assessed using the Risk Of Bias In Non-randomized Studies-of Interventions tool. OUTCOMES We identified 15 studies reporting on total testosterone levels of which five studies also reported on testicular volume and one study on erectile dysfunction. Men with Klinefelter syndrome and men with non-obstructive azoospermia had the strongest decrease in total testosterone levels 6 months after TESE, with a mean decrease of 4.1 and 2.7 nmol/l, respectively, which recovered again to baseline levels 26 and 18 months after TESE, respectively. At 6 months after TESE, some studies reported serum total testosterone concentrations below a cut-off value of 12 nmol/l, where symptoms and signs related to hypogonadism may appear. Furthermore, an increased prevalence of erectile dysfunction related to decreased total testosterone levels 6 months after TESE was reported. Also, in some men a decrease in testicular volume was reported. However, it is not clear if this is related to low testosterone levels. WIDER IMPLICATIONS The transient, but statistically significant, decrease in total testosterone levels indicates that men are at risk of developing a temporary hypogonadism after TESE, but there is insufficient evidence for whether patients actually experience clinical symptoms in case of decreased serum testosterone levels. To be able to properly counsel TESE patients, more large-scale monitoring on signs and symptoms of hypogonadism, in combination with testosterone measurements, needs to be performed in men undergoing TESE.
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Affiliation(s)
- Jitske Eliveld
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andreas Meißner
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Fulco van der Veen
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ans M M van Pelt
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Yu Y, Xi Q, Wang R, Zhang H, Li L, Liu R, Pan Y. Heterogenicity of testicular histopathology and tubules as a predictor of successful microdissection testicular sperm extraction in men with nonobstructive azoospermia. Medicine (Baltimore) 2018; 97:e10914. [PMID: 29851822 PMCID: PMC6392630 DOI: 10.1097/md.0000000000010914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Only a few studies evaluate the presence of spermatozoa intraoperatively. The study aimed to assess whether the heterogenicity of testicular histopathology and seminiferous tubules can predict the outcome of microdissection testicular sperm extraction (micro-TESE) in men with nonobstructive azoospermia (NOA).The study comprised a retrospective analysis of 94 patients with azoospermia who were referred from 2016 to 2017. Under optical magnification, they were classified into 2 groups based on the diameter of tubules intraoperatively, namely homogeneous tubules and heterogeneous tubules. Postoperatively, patients were divided into 2 groups of heterogeneous histopathology and homogeneous histopathology according to the 8 histopathological classification subgroups. The sperm retrieval rate was the main outcome.Testicular spermatozoa were successfully retrieved in 27 men (28%). The sperm retrieval rate in those with heterogeneous histopathology was higher than men with homogeneous histopathology (47% vs 12%; P < .001). The sperm retrieval rate of each histopathological subgroup in men who had the heterogeneous histopathology was higher, compared with the homogeneous histopathology (Sertoli cell only [SCO]: 30% vs 6%; maturation arrest [MA]: 38% vs 0%; tubular hyalinization: 42% vs 20%, respectively). Under the optical magnification, the sperm retrieval rate was significantly higher in men with heterogeneous vs homogeneous tubules (65% vs 15%, P < .001). Moreover, the sperm retrieval rate of the contralateral testicular was higher in men who had heterogeneous tubules, compared with the homogeneous tubules (25% vs 3%; P = .036).Heterogenicity of histopathology is an effective predictor in men with histopathological information available from a previous diagnostic biopsy or conventional TESE attempt preoperatively for successful sperm retrieval. Homogeneous tubules seem beneficial for some patients to perform a limited (superficial) contralateral micro-TESE after no spermatozoa were identified initially.
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Affiliation(s)
- Yang Yu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Qi Xi
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ruixue Wang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Hongguo Zhang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Leilei Li
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Ruizhi Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
| | - Yuan Pan
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital
- Jilin Engineering Research Center for Reproductive Medicine and Genetics, Jilin University, Changchun, China
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Zhang J, Liu GH, Zhao LG, Liang XY, Wang ZY. [Micro-dissection testicular sperm extraction for patients with non-obstructive azoospermia: A report of 196 cases]. Zhonghua Nan Ke Xue 2017; 23:804-807. [PMID: 29726661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of micro-dissection testicular sperm extraction (microTESE) for patients with non-obstructive azoospermia (NOA) and the indications of the strategy. METHODS This retrospective study included 196 cases of NOA undergoing microTESE in our center from September 2014 to March 2017. We recorded the sperm retrieval rate (SRR) and analyzed its correlation with the patients' age, testis volume, level of blood follicle-stimulating hormone (FSH), and etiological factors. RESULTS Testicular sperm were successfully retrieved from 87 (44.4%) of the patients. No significant correlation was found between the SRR and the patients' age, testis volume, or blood FSH level (P >0.05). As regards etiological factors, the SRR was 100% (29/29) in the patients with orchitis, 66.7% (16/24) in those surgically treated for cryptorchidism, 55.6% (10/18) in those with other secondary testis lesions, 60.0% (3/5) in those with AZFc deletion, 40.9% (9/22) in those with severe idiopathic testicular atrophy, 21.4% (12/56) in those with idiopathic NOA, 20.5% (8/39) in those with Klinefelter's syndrome, and 0% (0/3) in those with other abnormal karyotypes. CONCLUSIONS MicroTESE is an effective strategy for sperm retrieval in NOA patients, and the SRR is correlated with etiological factors but not with the FSH level or testis volume of the patients.
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Affiliation(s)
- Jing Zhang
- Center of Reproductive Medicine, The Sixth Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong 510620, China
| | - Gui-Hua Liu
- Center of Reproductive Medicine, The Sixth Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong 510620, China
| | - Lu-Gang Zhao
- Center of Reproductive Medicine, The Sixth Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong 510620, China
| | - Xiao-Yan Liang
- Center of Reproductive Medicine, The Sixth Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong 510620, China
| | - Zhong-Yang Wang
- Center of Reproductive Medicine, The Sixth Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong 510620, China
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Hu HR, Nie HC, Yang WM, Sun Y, Huang H, Xie FG. [Trigger effect of hMG and hCG in the treatment of unexplainable non-obstructive azoospermia]. Zhonghua Nan Ke Xue 2017; 23:813-816. [PMID: 29726663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate whether the trigger effect of human menopausal gonadotropins (hMG) and human chorionic gonadotropins (hCG) attributes to the treatment of unexplainable non-obstructive azoospermia (NOA). METHODS We retrospectively analyzed the clinical data about 282 cases of unexplainable NOA treated in the Maternity and Child Health Hospital of Guizhou Province from January 2010 to May 2017. All the patients underwent trigger treatment by intramuscular injection of hMG at 75 IU 3 times a week for 2 weeks, followed by hCG at 2 000 IU twice a week for another 2 weeks, and meanwhile took vitamin E, Levocarnitine and Tamoxifen as an adjunctive therapy. The treatment lasted 3-12 months. RESULTS Fifty-eight of the 255 patients that completed the treatment were found with sperm in the semen after treatment, all with severe oligoasthenospermia. Forty-seven of the 58 cases received assisted reproductive technology (ART), of which 18 achieved clinical pregnancy. Semen centrifugation revealed no sperm in the other cases, of which 6 were found with epididymal sperm at epididymal and testicular biopsy after treatment and 3 of them achieved clinical pregnancy after ART. Sperm was found in the semen or at epididymal or testicular biopsy in 64 of the patients after treatment, with an effectiveness rate of 25.1%. CONCLUSIONS Trigger treatment by injection of hMG and hCG combined with adjunctive oral medication has a certain effect on unexplainable NOA.
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Affiliation(s)
- Hao-Rui Hu
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Guizhou Province / Maternity and Child Health Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Hong-Chuan Nie
- Human Sperm Bank, CITIC-Xiangya Hospital of Reproduction and Genetics, Changsha, Hunan 410007, China
| | - Wei-Min Yang
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Guizhou Province / Maternity and Child Health Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Yuan Sun
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Guizhou Province / Maternity and Child Health Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Hui Huang
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Guizhou Province / Maternity and Child Health Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Fang-Gang Xie
- Department of Assisted Reproduction, Maternity and Child Health Hospital of Guizhou Province / Maternity and Child Health Hospital of Guiyang, Guiyang, Guizhou 550002, China
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Thornhill JA, Fanning DM, Davis NF, Ward F, Shamoun O, Brinsden P. Testicular Sperm Extraction and Intracytoplasmic Sperm Injection: Outcomes in a specialist fertility centre. Ir Med J 2015; 108:263-265. [PMID: 26625647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Assisted reproduction with testicular sperm extraction (TESE) and intra-cytoplasmic sperm injection (ICSI) are fertility treatment options for couples with severe oligospermia or azoospermia. A retrospective review was performed of 146 TESE procedures in a specialist fertility centre in Ireland. The indication for TESE was obstructive azoospermia (OA) in 59% (n = 80) and non-obstructive azoospermia (NOA) in 41% (n = 56). Sperm retrieval rates after TESE were determined and the pregnancy rates per ICSI cycle number were evaluated. Sperm retrieval rates were 99% (n = 79/80) and 32% (n = 18/56) for OA and NOA men respectively. Fifty-eight couples proceeded to ICSI. Overall 114 ICSI cycles were performed and 33 cycles resulted in fertilisation (29%). Our sperm retrieval and pregnancy rates are consistent with international studies and support the ongoing role for TESE and ICSI as successful assisted reproductive techniques for male factor infertility in Ireland.
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Niederberger C. Re: Optimization of spermatogenesis-regulating hormones in patients with non-obstructive azoospermia and its impact on sperm retrieval: a multicentre study. J Urol 2013; 190:2209. [PMID: 24209557 DOI: 10.1016/j.juro.2013.08.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/17/2022]
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Dadkhah F, Hosseini SJ, Sadighi Gilani MA, Farrahi F, Amini E, Kazeminejad B. Optimal number of biopsies and impact of testicular histology on the outcome of testicular sperm extraction. Urol J 2013; 10:795-801. [PMID: 23504685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To determine the optimal number of biopsies in patients with non-obstructive azoospermia (NOA) who undergo testicular sperm extraction (TESE), and assess the impact of testicular histology on outcome. MATERIALS AND METHODS Seven hundred and forty-one patients with NOA who underwent TESE in our institution were enrolled in the study. Testicular sperm extraction was performed applying an open surgical technique on the larger testis. The number of biopsies varied according to the presence or absence of spermatozoa. No further biopsies were obtained once spermatozoa were detected. If no spermatozoa were seen, the procedure was continued to a maximum number of 5 biopsies, including a single biopsy of the contralateral testis. RESULTS Spermatozoa were obtained in 330 (44.5%) patients after a single biopsy. The success rate increased to 381 (51.4%), 416 (56.1%), 433 (58.4%), and 441 (59.5%) after the second, third, fourth, and contralateral sampling, respectively. Multiple sampling increased the success rate; however, success rate did not increase considerably after the third sampling. Performing contralateral testicular biopsy was advantageous in patients with uniform or mixed pattern hypospermatogenesis. CONCLUSION We recommend performing at least 3 biopsies in patients with NOA who undergo TESE. Further biopsies may also be advantageous when the NOA is a consequence of either uniform or mixed pattern hypospermatogenesis.
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Affiliation(s)
- Farid Dadkhah
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran
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Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007; 13:539-49. [PMID: 17895238 DOI: 10.1093/humupd/dmm029] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our objective was to establish which is the best sperm retrieval technique in non-obstructive azoospermia based on the available evidence. To date, no randomized controlled trial has compared the efficiency of these strategies and thus current recommendations are based on cumulative evidence provided by descriptive, observational and controlled studies. Three outcome measures were assessed for the sperm retrieval techniques: sperm retrieval rate (SRR), complications and live birth rate. Twenty-four descriptive studies reporting on the results of testicular sperm extraction (TESE) were encountered. Seven controlled studies that compared microdissection (MD) TESE with conventional TESE and seven controlled studies comparing fine needle testicular aspiration (FNA) with TESE were identified. The mean SRR for TESE was 49.5% (95% CI 49.0-49.9). TESE with multiple biopsies results in a higher SRR than FNA especially in cases of Sertoli-cell-only (SCO) syndrome and maturation arrest. Current evidence suggests that MD performs better than conventional TESE only in cases of SCO where tubules containing active focus of spermatogenesis can be identified. MD appears to be the safest technique regarding post-operative complications followed by FNA. Only three studies could be identified concerning the influence of the sperm retrieval technique on clinical pregnancy and live birth rate, hence no definitive conclusions can be made. However, so far there appears to be no impact of the technique itself on success rates.
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Affiliation(s)
- P Donoso
- Reproductive Medicine Unit, Clinica Alemana, Vitacura 5951, Santiago, Chile.
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