Testicular Sperm Extraction in Non-Obstructive Azoospermic Patients with Sertoli Cell-Only Syndrome Testicular Histology

Abstract

INTRODUCTION: Sertoli cell-only syndrome (SCOS) is a prevalent cause of non-obstructive azoospermia (NOA) in males, where seminiferous tubules exclusively contain Sertoli cells, leading to minimal or absent spermatogenesis. Success rates for sperm retrieval in these cases vary significantly. We aimed to investigate the sperm retrieval rate with microdissection TESE (mTESE) in NOA patients with SCOS testicular histology and the factors that may affect it. MATERIAL AND METHODS: Patients who underwent mTESE due to NOA were retrospectively evaluated. Only patients with a histopathological diagnosis of SCOS were included in the study. Those with other histopathological diagnoses, those who underwent conventional TESE (cTESE) were excluded from the study. The sperm retrieval rate after mTESE was calculated for patients with a pathology result of SCOS. The age, testicular volume, and Follicle-Stimulating Hormone (FSH) level of the groups with and without sperm were compared. RESULTS: In our study, 186 patients with testicular histopathology diagnosed as SCOS were included. The rate of sperm retrieval after TESE in these patients was 28%. In patients with retrieved sperm, the mean age was 33.8 ± 5.4 years, the mean testicular volume was 11.1 ± 6.3 ml, and the mean FSH level was 22.5 ± 12.7 mIU/ml. In patients without retrieved sperm, the mean age was 33.8 ± 6.1 years, the mean testicular volume was 10.3 ± 6.1 ml, and the mean FSH level was 21.0 ± 9.8 mIU/ml. There was no significant difference observed in mean age, testicular volume, and FSH level between the group with retrieved sperm and the group without retrieved sperm (p=0.97, p=0.24, p=0.38, respectively). CONCLUSION: The findings of our study can be used for counseling men with NOA. Obtaining intratesticular sperm is possible in the presence of NOA and a diagnosis of SCOS histology. Therefore, patients undergoing testicular biopsy with TESE for histological examination can simultaneously prepare for intracytoplasmic sperm injection if sperm is found.