Abstract
BackgroundTo provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE. The aim of our study was to determine the impact of different parameters, including testicular histopathology, on sperm retrieval in case of reoperation in patients undergoing testicular sperm extraction.MethodsWe retrospectively analyzed 486 patients who underwent sperm extraction for intracytoplasmic sperm injection and testicular biopsy. Histology was classified into: normal spermatogenesis; hypospermatogenesis (reduction in the number of normal spermatogenetic cells); maturation arrest (absence of the later stages of spermatogenesis); and Sertoli cell only (absence of germ cells). Semen analysis and serum FSH, LH and testosterone were measured.ResultsFour hundred thirty patients had non obstructive azoospermia, 53 severe oligozoospermia and 3 necrozoospermia. There were 307 (63%) successful sperm retrieval. Higher testicular volume, lower levels of FSH, and better histological features were predictive for sperm retrieval. The same parameters and younger age were predictive factors for shorter time for sperm recovery. After multivariable analysis, younger age, better semen parameters, better histological features and lower values of FSH remained predictive for shorter time for sperm retrieval while better semen and histology remained predictive factors for successful sperm retrieval. The predictive capacity of a score obtained by summing the points assigned for selected predictors (1 point for Sertoli cell only, 0.33 points for azoospermia, 0.004 points for each FSH mIU/ml) gave an area under the ROC curve of 0.843.ConclusionsThis model can help the practitioner with counseling infertile men by reliably predicting the chance of obtaining spermatozoa with testicular sperm extraction when a repeat attempt is planned.
Highlights
To provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE
With the only exception of body mass index [Body mass index (BMI), weight/height (m2)] and circulating T, all the other parameters differed significantly between the patients that experienced successfull sperm recovery (SR) compared to those that had unsuccessfull SR, including age that was older in the successfull SR group, follicle stimulating hormone (FSH) and luteinizing hormone (LH) whose values were higher in the unsuccessfull SR group, and testis volume that was lower in the unsuccessfull SR group
Statistical difference in sperm retrieval rate was observed between all the groups with a pattern of increasing likelihood of SR from Sertoli cell only (SCO) to Maturation arrest (MA), HypoS and Normal spermatogenesis (NormoS)
Summary
To provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE. One of the major challenge with conventional TESE (cTESE) was to find indicators of the likelihood to recover spermatozoa. From time to time, circulating hormonal markers, testicular ultrasound and testicular biopsy have been used [2]. None of these procedures has proved effective because often, due to the profound heterogeneity of the testicular tissue, spermatozoa were recovered even in the presence of indicators suggestive for adverse outcomes. Many groups have argued that the mTESE provides such a high SR compared to other techniques, even in case of severe histological diagnosis like agenesis of the germinal line, that cTESE and as a logical consequence all the procedures to predict the chances of SR, were put aside as techniques of historical interest not relevant to current reproductive technologies [3,4,5,6,7]
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