Sperm retrieval rates (SRR) and clinical outcomes after testicular sperm extraction (TESE) in the etiology of azoospermia

Abstract

In assisted reproductive techniques, it is necessary to collect clinical outcomes in a separate group of patient background and provide it for patients. Sperm retrieval rates (SRR) and clinical outcomes after intracytoplasmic sperm injection (ICSI) with testicular sperm in the etiology azoospermia have hardly been investigated. We report that ICSI outcomes in men undergoing TESE have performed in our clinic latest three years. A retrospective study in the etiology of azoospermia. The studies applied conventional TESE (n=165) for OA patients, ED patients, and oligozoospermic patients and microdissection TESE (micro TESE) (n=843) for NOA patients performed in our clinic between September 2013 and March 2017 were used to analyze for SRR. Azoospermia in a patient with normal-size testes (>16mL) and normal FSH suggested obstructive etiology. The diagnosis of OA also required confirmation of normal spermatogenesis by testicular biopsy. The etiology of NOA included unexplained NOA, Klinefelter syndrome, azoospermia factor (AZF) c microdeletion of the Y chromosome, and post chemotherapy NOA. In addition, a total of 396 couples had 727 TESE-ICSI cycles (94 couples and 170 TESE-ICSI cycles for OA and 302 couples and 557 cycles for NOA) were evaluated in embryonic development rates and clinical pregnancy rates (CPR). Spermatozoa were retrieved 100% (118/118) of obstructive azoospermia (OA), 40.6% (43/106) of Klinefelter syndrome (KS), 20.5% (98/479) of unexplained NOA (NOA), 81.8% (27/33) of AZFc microdelection, and 40.9% (18/44) of post chemotherapy NOA. SRR of OA was significantly higher and unexplained NOA were lower than any other groups. SRR with the primary TESE (49.7%) is significantly higher than with the TESE after who had previously undergone with no sperm found (31.0%) (P<0.001). Especially, the significant difference was observed in KS (48.8% and 15.4%, p<0.01) and unexplained NOA (23.9% and 12.5%, p<0.01), respectively. Two pronuclei (2PN) rates in OA (64.0%) and post chemotherapy NOA (69.3%) were significantly higher, but in AZFc microdelection (47.0%) was significantly lower than any other groups. Blastocyst development rate in AZFc microdelection (33.9%) was significantly lower than any other groups and the rates in KS (41.9%) was lower than in OA (50.8%). Good-quality blastocyst rates in OA (42.6%) and post chemotherapy NOA (45.2%) were significantly higher, but the rate in AZFc microdelection (33.9%) was lower than any other groups. CPR per embryo transfer cycle was lower in unexplained NOA (30.0%), KS (28.6%) and AZFc microdelection (26.6%) than in OA (42.4%). Micro TESE is particularly helpful for successful sperm retrieval in KS and AZFc microdeletion cases, however, the motile and better sperm retrieval from testicular tissue seems to be a critical key to succeed and rationale for good embryonic development and clinical pregnancy.