Sperm retrieval rates and clinical outcomes with testicular sperm extraction in relation to the etiology of azoospermia

Abstract

Sperm retrieval rates (SRR) and clinical outcomes after intracytoplasmic sperm injection (ICSI) in testicular sperm extraction (TESE) cases in relation to the etiology of azoospermia have not well been investigated yet. Here we report our latest five-year experience in TESE. Retrospective clinical analysis. This study investigated SRR of conventional TESE in obstructive azoospermia (OA) and microdissection TESE in cryptozoospermia and non-obstructive azoospermia (NOA) patients between September 2013 and December 2018 (1455 TESE attempts with 1222 patients). The etiologies of NOA were categorized as unexplained, Klinefelter’s syndrome (KS), post chemotherapy, post orchiopexy, and microdeletion of azoospermia factor (AZF) c on the Y chromosome. A total of 473 couples had 1128 TESE-ICSI cycles (136 couples and 332 cycles with OA and 337 couples and 796 cycles with NOA) were evaluated with respect to fertilization, embryonic development and clinical pregnancy rates (CPR). SRR of patients with first TESE attempts (49.9%) was significantly higher than that of patients who previously failed sperm retrieval (32.5%) (P<0.001). In the first TESE cases, SSRs were 100% (155/155) in OA, 21.2% (102/482) in unexplained NOA, 50.5% (54/107) in KS, 47.8% (22/46) in post chemotherapy, 75.0% (33/44) in post orchiopexy, and 87.1% (27/31) in AZFc microdeletion, respectively. SRR of OA was significantly higher, while that of unexplained NOA was lower than any other groups. Normal fertilization rates in OA (62.0%) and post chemotherapy (63.4%) were significantly higher, but that of AZFc microdelecion (39.7%) was significantly lower than any other groups. Blastocyst development rate and good-quality blastocyst rate in AZFc microdeletion (27.4% and 9.3%) were significantly lower than any other groups and the rates in KS (40.5% and 15.1%) were lower than in OA (51.3% and 22.1%), post chemotherapy (50.6% and 23.6%), and post orchiopexy (52.1% of blastulation). CPRs per embryo transfer were lower in unexplained NOA (29.7%), and AZFc microdeletion (27.5%) than in OA (39.9%). We have had a total of 243 newborns so far with comparable congenital anomaly rate comparing to those with ejaculated sperm-ICSI. The success of sperm recovery, fertilization and pre- and post-implantation development was significantly influenced by the etiology of azoospermia. However, the offspring with testicular sperm was as healthy as that with ejaculated sperm at least in our experience.