Predictive factors of successful microdissection testicular sperm extraction.

Aaron M Bernie,Peter N Schlegel,Ranjith Ramasamy

doi:10.1186/2051-4190-23-5

Abstract

Azoospermia in men requires microsurgical reconstruction or a procedure for sperm retrieval with assisted reproduction to allow fertility. While the chance of successful retrieval of sperm in men with obstructive azoospermia approaches >90%, the chances of sperm retrieval in men with non-obstructive azoospermia (NOA) are not as high. Conventional procedures such as fine needle aspiration of the testis, testicular biopsy and testicular sperm extraction are successful in 20-45% of men with NOA. With microdissection testicular sperm extraction (micro-TESE), the chance of successful retrieval can be up to 60%. Despite this increased success, the ability to counsel patients preoperatively on their probability of successful sperm retrieval has remained challenging. A combination of variables such as age, serum FSH and inhibin B levels, testicular size, genetic analysis, history of Klinefelter syndrome, history of cryptorchidism or varicocele and histopathology on diagnostic biopsy have provided some insight into the chance of successful sperm retrieval in men with NOA. The goal of this review was to evaluate the preoperative factors that are currently available to predict the outcome for success with micro-TESE.

Highlights

Men undergoing evaluation for infertility are found to have azoospermia, or lack of sperm in the ejaculate, up to 10% of the time [1]
Tsujimura et al have reported that preoperative serum Follicle-stimulating hormone (FSH) level in combination with other factors may help predict the success of micro-testicular sperm extraction (TESE) [19]
With regards to micro-TESE, we have previously shown that men with high FSH have similar or better sperm retrieval compared to those with lower FSH [24,25]

Summary

Introduction

Men undergoing evaluation for infertility are found to have azoospermia, or lack of sperm in the ejaculate, up to 10% of the time [1]. We will evaluate preoperative variables such as age, FSH, testicular volume, inhibin B, genetics, Klinefelter syndrome, history of varicocele, cryptorchidism, as well as intraoperative variables such as histopathology and tubular diameter and their relevance for predicting the outcome of micro-TESE. These variables were determined by reviewing the available literature on prediction of success in sperm retrieval techniques, with a focus on those reviews that are dedicated to micro-TESE.

Serum FSH

Serum Inhibin B

Testicular volume

Findings

Conclusions