Abstract
To evaluate and compare left and right testicular tissue histopathology and Johnsen score, and to investigate the necessity for bilateral testicular biopsy. We recruited180 patients with non-obstructiveazoospermia (NOA) on testicular biopsy who had undergonetesticular sperm aspiration (TESA). Pathological sections of testicular tissue were diagnosed by specially-assigned doctors, who evaluated pathological findings, determined the Johnsen score and confirmed for the presence or absence of sperm. Sperm positive rates for left and right testicular histopathology were 55.0% and 51.7% respectively, and the proportion of Johnsen scores≥8 for left and right testes were 53.3% and 50.0%, respectively. Cohen kappa values revealed that the identification of sperm in bilateral testicular samples was not consistent and was related to random effects; Optimized cut-off value for bilateral testicular volume was 11ml (Johnsen score ≥8), and optimized cut-off values of E2 on left and right testes were 144.5pmol/L and 133.5 pmol/L (Johnsen score≤7). However, age, serum prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) levels were not accurate predictors for the existence of testicular sperm. There was nostatistical significance between left and right testicular histopathology in terms of sperm positive rates or Johnsen score; the Johnsen score were caused entirely by random effects and a score from one side could not represent the other side. Therefore, we recommend that both testes need to undergo surgery when NOA patients undergo testicular biopsy or sperm retrieval.
Highlights
Owing to developments in andrology, reproductive medicine and assisted reproductive technology (ART), it has been possible to use testicular sperm retrieval to allow patients with non-obstructive azoospermia (NOA) to father their own children
Several studies have concluded that testicular biopsy was the best predictor of a successful testicular biopsy who had undergonetesticular sperm aspiration (TESA)/TESE, and that the strongest predictor of the success of TESA/TESE was when tubules were found in histopathology specimens which contained mature spermatozoa (Johnsen score ≥8)
General data from the 180 patients are presented in Table 1; bilateral testicular volume was unequal in 25.0% of these patients
Summary
Owing to developments in andrology, reproductive medicine and assisted reproductive technology (ART), it has been possible to use testicular sperm retrieval to allow patients with non-obstructive azoospermia (NOA) to father their own children. In order to achieve successful diagnosis and provide appropriate therapy for NOA patients, it is necessary for andrologists to carry out testicular biopsy and testicular sperm aspiration/extraction (TESA/TESE), or select one of these two techniques to confirm the existence or absence of testicular sperm and evaluate the positive rate of sperm retrieval before commencing a cycle of intracytoplasmic sperm injection (ICSI). The lower limit threshold of 2% of tubules showing active spermatogenesis in a histopathology specimen would result in a positive sperm retrieval and retrieval rate of 50% for NOA patients [2]. The SRR of cTESE is lower than micro-TESE, and physicians have agreed that micro-TESE should be considered as the gold standard for the retrieval of testicular sperm in NOA patients, and that a significant proportion of men undergoing microTESE would have successful sperm retrieval irrespective of previous histology or previous unsuccessful surgery [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
