Microdissection of testicular sperm extraction in non-obstructive azoospermia patients

Abstract

Objective To evaluate the outcomes of microdissection testicular sperm extraction (MD-TESE) and conventional testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA).And to investigate the factors that influence the sperm retrieval rate (SRR) of the MD-TESE.Methods One hundred and seven non-obstructive azoospermia patients accepting conventional TESE and MD-TESE in our institute.Testicular tissues were minced and observed under microscope with 400 magnification.The relationships between SRR and testis volume,serum FSH and pathological category were analyzed.Results There were 46 patients retrieved testicular sperm successfully in conventional TESE,versus 61 patients in TESE combined with MD-TESE.Compared with conventional TESE about pathological types,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of Sertoli cell only syndrome (SCOS,45.1％:32.4％,P ＜ 0.01) than in the groups of maturation arrest (MA,59.1％:40.9％,P=0.25) andhypospermatogenesis (HS,92.9％:78.6％,P=0.5).At the meantime,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of HS (92.9％) than in the groups of SCOS (45.1％) and MA (59.1％).Compared with conventional TESE about testicular volume,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＜10mland ＞6 ml (54.2％:31.3％,P＜0.01 =than in the groups of ＞15 ml (55.6％:50.0％,P =1.0) and 10-15 ml (61.0％:53.7％,P =0.25).However,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 15 ml,10-15 ml,＜ 10 ml and ＞6 ml (55.6％,61.0％,54.2％,respectively,P =0.77).Compared with conventional TESE about serum FSH concentration,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＞ 12.6IU/L (56.9％:41.7％,P＜0.01 =than in the group of ≤12.6 U/L (45.7％:57.1％,P=0.125).But,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 12.6 U/L,≤12.6 U/L (56.9％,57.1％,respectively,P =0.98).Conclusions Sperm retrieval rate of TESE combined with MD-TESE was significantly higher than conventional TESE.And sperm retrieval rate was associated with pathological types.Testicular volume and serum FSH concentration were not indexes of the success of TESE combined with MD-TESE. Key words: Microdissection of testicular sperm extraction; Testicular sperm extraction; non-obstructive azoospermia; Sperm retrieval rate