Factors anticipating difficulty in testicular sperm extraction and their influence on schedule planning and surgical technique in non-obstructive azoospermic patients.

Abstract

Objective: To establish some clinical and non invasive laboratory parameters in order to select the proper surgical sperm retrieval technique and to organise an adequate schedule for testicular sperm extraction (TESE) in non obstructive azoospermia in relation to ovum pick up if it is done consecutively. Design: Retrospective clinical study. Materials/Methods: Fifty two patients with non obstructive azoospermia were subjected to full history, testicular size measurement, FSH estimation and consecutive semen analyses stained with May-Grünwald-Giemsa (MGG) and Nuclear Fast Red and picroindigocarmine (NF-PICS) stains to identify spermatogenic cells and spermatozoa prior to surgery. Testicular sperm extraction was carried out with microdissection and conventional open surgical methods. Bilateral testicular biopsies were taken for histopathology. Statistical analysis was carried out to evaluate the predictive potential of these parameters. Results: The total sperm recovery rate (SRR) was 31/52 (59.6%). According to difficulty encountered during TESE patients were classified into two groups (A and B). In group A (34 patients) where TESE was difficult and necessitated multiple bilateral microsurgical and conventional samples SRR was 13/34 (38.2%) and in 5 of these subjects more than 12 hours were necessary for sperm collection. While in group B (18 patients) one or two small microsurgical samples were sufficient to retrieve motile sperm in all patients (SRR = 100%). The difference in SRR between the 2 groups couldn’t be attributed to specific histopathologic pattern, FSH or testicular volume, but difficult sperm retrieval was observed in older ages, in patients with long duration of infertility, when no spermatids were detected in the ejaculate and when the microscopic appearance of the seminiferous tubules were homogeneous. Conclusions: If ovum pickup is planned in the same day of testicular biopsy surgical sperm retrieval is advised to be done at least 8 hours before ovum pick in old age group, in patients with long duration of infertility and when no spermatids are detected in the ejaculate to minimise the risk of in vitro post maturity oocyte damage. Small microsurgical samples are the ideal option if tubules are heterogeneous. On the other hand homogeneous aspect may necessitates multiple large conventional biopsies to be treated with erythrocyte lysing buffer to obtain the highest SRR. Supported by: Adam International Clinic, Mohandesseen, Cairo, Egypt.