Clinical outcomes of microdissection testicular sperm extraction (micro TESE) and intracytoplasmic sperm injection (ICSI) in non-obstructive azoospermia (NOA) with the history of cryptorchidism

Abstract

Undescended testis (UT) is associated with impairment of germ cell maturation and subsequent infertility in adulthood because the UT is exposed to a higher temperature compared with the scrotal temperature and there is progressive Leydig and Sertoli cell atrophy. There has been very few studies of ICSI with a focus on, or large enough numbers to examine, the specific outcomes associated with male factor infertility including NOA with the history of cryptorchidism. A retrospective study in a reproductive center. This study was conducted in 50 NOA patients post cryptorchidism, 526 unexplained NOA patients without past history (unexplained NOA; not including after orchidopexy, Klinefelter syndrome, cryptozoospermia, mumps orchitis, etc), and 141 OA patients and the ICSI outcomes of their wives were assessed between September 2013 to December 2017. We evaluated sperm retrieval rate (SRR) of micro dissection TESE (micro TESE), two pronuclei (2PN) oocyte rates, blastocyst development rates, good-quality blastocyst (Grade 3BB and above on day 5 by the Gardner scoring) rates, and clinical pregnancy rates per embryo transfer (ET) in 33 cases the history of UT, 96 cases of unexplained NOA, and 123 cases of OA. The wives age at ICSI post cryptorchidism, unexplained NOA, and OA were 34.1±3.6 years, 34.9±3.8 years, and 34.6±4.8 years, respectively. SRR of micro TESE in NOA with the history of cryptorchidism (32/50=64.0%) was higher than unexplained NOA (107/526=20.3%) (p<0.001). No correlation was found between serum FSH, LH, and T level with the success of sperm retrieval. Testicular volume and patient age at orchidopexy also did not affect the SRR for micro TESE. 2PN oocyte, blastocyst development, and good-quality blastocyst rates were 52.5%, 54.7%, and 22.4% in NOA post cryptorchidism, 54.5%, 47.2%, and 19.3% in unexplained NOA, and 62.3%, 52.2%, and 21.9% in OA, respectively. 2PN oocyte rate of NOA post cryptorchidism and unexplained NOA were lower than OA (P<0.001). Blastocyst development rate of unexplained NOA was lower than OA (P<0.05). Clinical pregnancy rates per ET were 33.8% in NOA post cryptorchidism, 29.0% in unexplained NOA, and 39.3% in OA, respectively (no significant difference). Seventeen healthy children have been born and 3 patients are on going pregnancy in NOA post cryptorchidism couples. Micro TESE is particularly helpful for sperm retrieval for NOA post cryptorchidism and ICSI outcomes in NOA post cryptorchidism are equivalent to unexplained NOA and OA.