Abstract
mic sperm injection (ICSI) with testicular sperm are yet to be elucidated. The objective of this study was to demonstrate the characteristics of Japanese azoospermic patients and to evaluate the outcomes of TESE-ICSI. METHODS: A total of 360 azoospermic men underwent microdissection TESE from October 2004 to May 2012. Since 2008 August, Y chromosome microdeletion has been routinely examined to exclude incurable cases. The backgrounds of azoospermic patients and their correlation with success rate were examined. Harvested testicular sperm were used for ICSI in fresh form or frozen/thawed form and frozen/thawed embryo transfer (ET) was performed on the day3 or day5. Clinical pregnancy rate (CPR), live birth rate (LBR), birth weight (BW) were surveyed retrospectively. RESULTS: SRR were 100% (71/71) in obstructive azoospermia (OA), 37% (89/244) in non-obstructive azoospermia (NOA) and 40% (18/45) in non-mosaic Klinefelter syndrome (KS). Sertoli cell only syndrome (SCO) occupied 61% (148/244) of NOA and SRR was 24% (35/148). In OA, most cases were idiopathic and none of them had history of vasectomy. In KS, SRR was 47% (17/36) under the age of 37, however 11% (1/9) over the age of 37. Among those who underwent bilateral microdissection TESE after failure at initial side testis, 6% (9/157) succeeded retrieving sperm at contra side testis in NOA, however 13% (4/31) succeeded in KS. Men with history of childhood orchiopexy, proof of past ejaculated sperm had a higher chance of testicular sperm retrieval (p 0.05). CPR, LBR and BW were not significantly different among the following subgroups. CPR was 72% (45/58) in OA, 67% (51/76) in NOA, and 71% (10/14) in KS. LBR was 89% (32/36) in OA, 84% (32/38) in NOA, and 100% (6/6) in KS. Median BW was 3102g (2062 3835, n 31) in OA, 3026g (2096 4194, n 16) in SCO, 3125g (1844 3796, n 18) in the rest NOA, and 3038g (1084 4118, n 6) in KS. CONCLUSIONS: In azoospermic Japanese, SCO was the most outstanding etiology, which may explain the lower SRR by microdissection TESE. The history of orchiopexy, proof of past ejaculated sperm and younger age in KS were the better prognostic factor. In most OA, their etiology was unknown probably because vasectomy is quite rarely performed in Japan. Once testicular sperm was retrieved, prognosis was not different regardless of their etiologies.
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