Diagnosis Of Nonobstructive Azoospermia Research Articles

Evaluation of serum inhibin B and inhibin B/FSH ratio in the diagnosis of non-obstructive azoospermia and oligozoospermia.

Infertility affects approximately 15 % of couples globally, with 50 % cases of male factor infertility. Precise assessment of spermatogenesis is essential for evaluating male infertility. Recent studies suggest serum inhibin B as a promising biomarker for testicular function. This study aims to evaluate the diagnostic utility of serum inhibin B in predicting male infertility, particularly focusing on its relationship with sperm count. A cross-sectional study was conducted on 80 adult men (mean age 31.4±6.89 years) presenting with infertility at gynecology and urology outpatient departments. Semen analysis was performed following WHO (2010) guidelines, and serum inhibin B levels were quantified. The correlation between serum inhibin B levels and sperm parameters was assessed using Pearson's correlation test. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of serum inhibin B and the inhibin B/FSH ratio for non-obstructive azoospermia (NOA) and oligozoospermia. A significant positive correlation was observed between serum inhibin B and sperm count (r=0.94, p<0.001). ROC analysis demonstrated that the inhibin B/FSH ratio had the highest diagnostic accuracy for NOA and oligozoospermia (AUC=0.986), with sensitivity of 100 % and specificity of 91.67 %. Serum inhibin B alone also showed high diagnostic value (AUC=0.965 for NOA and 0.969 for oligozoospermia). Serum inhibin B is a reliable biomarker for assessing male infertility, particularly in evaluating spermatogenic function. The inhibin B/FSH ratio provides superior diagnostic accuracy for NOA and oligozoospermia, offering valuable clinical utility in male infertility diagnosis.

Clinical parameters as predictors for sperm retrieval success in azoospermia: experience from Indonesia.

Azoospermia is the most severe type of male infertility. This study aimed to identify useful clinical parameters to predict sperm retrieval success. This could assist clinicians in accurately diagnosing and treating patients based on the individual clinical parameters of patients. A retrospective cohort study was performed involving 517 patients with azoospermia who underwent sperm retrieval in Jakarta, Indonesia, between January 2010 and April 2023. Clinical evaluation and scrotal ultrasound, serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were evaluated before surgery. Multivariate analyses were conducted to determine clinical parameters that could predict overall sperm retrieval success. Further subgroup analysis was performed to determine the factors that the diagnosis of non-obstructive azoospermia (NOA) diagnosis and sperm retrieval success among patients with NOA. A total of 2,987 infertile men attended our clinic. Men with azoospermia (n=517) who met the inclusion criteria and did not fulfil any exclusion criteria were included in the study. The overall sperm retrieval success was 47.58%. Logistic regression revealed that FSH 7.76 mIU/mL (sensitivity: 60.1%, specificity: 63.3%, p<0.001); longest testicular axis length 3.89 cm (sensitivity: 33.6%, specificity: 41.6%); and varicocele (p<0.001) were independent factors for overall sperm retrieval. The FSH cutoff of 7.45 mIU/mL (sensitivity: 31.3%, specificity: 37.7%, p<0,001); longest testicular axis length 3.85 cm (sensitivity: 76.7%, specificity: 65.4%, p<0.001); and varicocele (p<0.001) were independent factors for NOA diagnosis. Varicocele was the only clinical parameter that significantly predicted the success of sperm retrieval in patients with NOA. FSH, LH, longest testicular axis, and varicocele are among the clinical parameters that are useful for predicting overall sperm retrieval success and NOA diagnosis. However, varicocele is the only clinical parameter that significantly predicts sperm retrieval success in patients with NOA. High-quality studies are required to assess the other predictors of sperm retrieval success.

TESTICULAR CORE BIOPSY PRIOR TO SURGICAL SPERM EXTRACTION: A NOVEL ALGORITHM FOR AZOOSPERMIA

Men who present to infertility clinics with a diagnosis of nonobstructive azoospermia are often recommended to undergo surgical sperm extraction necessitating an operating room before proceeding with in-vitro fertilization (IVF) with microscopic intracytoplasmic sperm injection (ICSI). Prior studies have reported the use of fine needle aspiration with a 23-gauge needle as a diagnostic tool in these patients; however, the use has been limited to cytological evaluation of spermatogenesis and interstitial cells.

MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE Shi-Jie Tsai, I-shen Huang, and William J. Huang Shi-Jie Tsai Shi-Jie Tsai More articles by this author , I-shen HuangI-shen Huang More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer per se or therapies, particularly treatment involved with chemotherapy, appears to potentiate gonadal toxicity. For men with persistent postchemotherapy azoospermia, fatherhood can be possibly achieved via microdissection testicular sperm extraction (mTESE) combine with intracytoplasmic sperm injection (ICSI). Yet, the recovery of viable testicular sperm with mTESE is unpredictable in this population. Using cyclophosphamide equivalent dose (CED) as a means of quantifying exposure to alkylating agent, a cytotoxic agent that has been demonstrated to disrupt spermatogenesis, we sought to discover the sperm retrieval rate in men with persistent azoospermia postchemotherapy in relation to CED. METHODS: We retrospectively reviewed records of 910 patients with the diagnosis of non-obstructive azoospermia who had undergone mTESE between 2010 to 2018 in our institution and enrolled 14 patients with a prior history of chemotherapy. The oncological data and chemotherapy regimen of each individual were reviewed. For each patient’s regimen received, a CED was calculated using the equation proposed by Daniel Green et al. in 2014. The pretreatment hormone profile, CED, and outcomes of mTESE were analyzed. RESULTS: Testicular spermatozoa were successfully retrieved in 6 (43%) of the patients. The mean patient age was 36 years (range, 27-42 years) and the mean time interval from chemotherapy to mTESE was 10.4 years (range, 1-26 years). Although CED and alkylating agent exposure were not predictive factors for successful sperm retrieval (p=0.14), however, no men with CED >4000 mg/m2 (n=4) had viable sperm detected in testis during mTESE. As for the other 10 patients without alkylating agent exposure (i.e. CED=0 mg/m2), sperm can be recovered in 6 (60%) of them. Regarding cancer subtypes, patients diagnosed with testicular non-seminomatous germ cell tumor had favorable sperm retrieval rate (3/5, 60%), compared to patients with non-Hodgkin’s lymphoma (0/3, 0%) or leukemia (1/2, 50%), respectively. CONCLUSIONS: The chance of successful sperm retrieval using mTESE for men with persistent postchemotherapy azoospermia and a calculated CED >4000 mg/m2 is zero. These patients should be properly counseled with the CED model before pursuing surgical sperm retrieval . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e557 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shi-Jie Tsai More articles by this author I-shen Huang More articles by this author William J. Huang More articles by this author Expand All Advertisement Loading ...

Nfertilite Tedavisinde TESE Başarısını Etkileyen Faktörler: Tek Merkez Deneyimi Ön Sonuçları

Objective: Today, infertility is a health problem with increasing treatment seeking. Testicular sperm extraction (TESE) is the only possible procedure to offer genetic parenting to men with nonobstructive azoospermia (NOA). Our aim in this study is to present our clinical experiences that affect the success of sperm retrieval in men with NOA in the light of the literature. Materials and Methods: In our study, patients who underwent TESE with a diagnosis of NOA between 2017-2020 were retrospectively analyzed. According to the TESE procedure; the patients were divided into two groups as conventional TESE and TESE performed under microscopic magnification (micro-TESE). Medical histories, hormone values, and physical examination findings of all patients were recorded. Results: Our micro-TESE success rate was found to be 100%. A positive correlation (rho 0.714, p = 0.009) was found between the factors affecting sperm retrieval , and the application of micro-TESE, and a negative correlation was detected with FSH levels (rho -0.759, p = 0.004). Conclusion: The success of sperm retrieval increases with the micro-TESE procedure. As FSH levels increase, sperm retrieval success rates decrease.

"Second-look" Micro Testicular Sperm Extraction (MicroTESE) in Patients with Non-obstructive Azoospermia Following Histopathological Analysis.

Introduction:Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA).Aim:This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the „second-look“ procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population.Methods:The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient’s history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for „second-look“ microTESE attempt.Results:Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a „second-look“ procedure after the evaluation of histopathological reports. After the stimulation therapy and „second-look“ procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038).Conclusion:Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the „second-look“ microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the “second-look” procedure.

MRI findings of nonobstructive azoospermia: lesions in and out of pelvic cavity.

Nonobstructive azoospermia (NOA) can be caused by various diseases, including congenital disorders, endocrine disorders, infections, tumor or tumor-like diseases, vascular diseases, etc. Diagnosis of the underlying cause of NOA is complicated and challenging. In this study, we introduce an MR examination protocol for the etiological diagnosis of NOA, and demonstrate a series of NOA patients with different causes and imaging findings. Except for lesions of testes, the patients may also combine abnormalities of adrenal glands and central nervous system. In such cases, the patients could benefit from additional abdominal and intracranial scans.

Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction: a pilot study.

To investigate the ability of some hematologic prognostic scores demonstrating inflammation in predicting sperm presence in testicular sperm extraction (TESE). We retrospectively investigated the medical data of 430 patients with the diagnosis of non-obstruc tive azoospermia (NOA) who had undergone TESE operation consecutively in our institution between the dates of January 2009 and February 2017. In all, 352 patients with the diagnosis of NOA, with bilaterally palpable vas deferens, who had undergone TESE for the first time, were included in the study. Patients with genetic anomalies, genital infection, history of surgery or vasectomy, chronic diseases, history of inflammatory, metabolic, rheumatologic, or malignant diseases, morbid obesity, with the diagnosis of clinical varicocele, or patients who had undergone TESE for the second time were excluded from the study. According to the results of TESE, the patients were divided into two groups as those with sperm retrieval and those without sperm retrieval. These groups were compared in terms of age, infertility duration, body mass index, hormone profile, hematologic parameters, neutrophil-to-lymphocyte ratio (NRL), monocyte-to-eosinophil ratio (MER), and platelet-to-lymphocyte ratio (PLR). The NLR and PLR levels were found to be significantly higher in patients without sperm retrieval at TESE compared to those with sperm retrieval. The logistic regression analysis showed NLR as an independent factor that showed the presence of spermatozoa at TESE (odds ratio: 4.786, %95 confidence interval: 2.667-8.589, p<0.001). The area under the ROC curve (AUC) for the PLR was determined to be 0.574. As the calculated AUC value of the PLR was below 0.6, there was insufficient evidence determined at TESE to say that it was a reliable marker to indicate the presence of spermatozoa. The area of the MER value under the ROC curve was not statistically significant. It has been demonstrated thatsystemic inflammation negatively affects the probability of extracting spermatozoa in TESE and NLR is an independent factor indicating the presence of spermatozoa in TESE.

Hormonal Imbalances and Psychological Scars Left Behind in Infertile Men

The effect of infertility on the psychological well-being of couples has been the subject of increasing attention in recent years. The frustration of couples of a relatively young age (ie, in their fourth decades) provokes not only anxiety and depression but also negative effects on the relationships. The objective of this study was to evaluate the effect of a diagnosis of male infertility on anxiety and depression in the men themselves and in fertile female spouses. The prospective cross-sectional study consisted of 264 participants, 72 males diagnosed with nonobstructive azoospermia (NOA) and their fertile spouses and 60 fertile couples attending our university between January 1, 2009, and April 30, 2010. The Beck Anxiety Inventory, Beck Depression Inventory (BDI), and hormone levels were measured during initial and follow-up visits. In NOA men, follicle-stimulating hormone and luteinizing hormone were positively associated with anxiety, in contrast to testosterone, which was inversely associated with anxiety. After the diagnosis of NOA, producing no testicular sperm, the panic intensity among men increased significantly, whereas their spouses exhibited less panic. By contrast, fertile female partners of NOA men reported higher BDI scores after the initial diagnosis of azoospermia, whereas their partners recorded higher levels of depression after the absence of testicular sperm was discovered. Insomnia was the most common complaint for both sexes after the diagnosis of azoospermia. Hormonal abnormalities had a negative effect on the quality of life. Physicians and clinicians should acknowledge the immense psychosocial effect of the diagnosis of male infertility on both males and their fertile female partners.

Success rate in icsi (intracytoplasmic sperm injection) treatment of men with non-obstructive azoospermia (NOA): a comparative study between tese (testicular sperm extraction) and microdissection-tese

OBJECTIVE: Compare the results from men with NOA who were submitted to either conventional TESE or to Microdissection-TESE and underwent assisted reproductive technology (ART) treatment in an ICSI protocol. DESIGN: Prospective observational and retrospective comparative study. MATERIALS AND METHODS: Sixty five couples, where men had been diagnosed with NOA, were submitted to Microdissection-TESE procedures for sperm retrieval (group 1). All procedures were scheduled one day prior to ICSI. Seminiferous tubuli were selected under 40x microscopic control and evaluated in the lab for the presence of sperm. Same setting contralateral testicular exploration was carried out as needed. In successful cases, the remaining specimens were cryopreserved for future use. For comparative purposes, we conducted a retrospective analysis of 471 patients with a diagnosis of NOA who underwent ART treatment and had been submitted to conventional TESE in our center (group 2). In all cases, a testicular equatorial incision with the excision of significant testicular samples was used for unilateral or bilateral testicular exploration. Sperm retrieval rate (SRR) and ART treatment outcomes in men who had positive sperm retrieval were studied. RESULTS: Mean male and female partner age in groups 1 and 2 were 38.5 ± 7.5 vs. 38.1 ± 8.0 (p=0.665) and 32.7 ± 4.9 vs. 33.4 ± 6.0 years (p=0.362), respectively. Including the cases where frozen sperm were used in subsequent ART treatment attempts, 78 ICSI cycles were performed in group 1 and 429 in group 2. The SSR was significantly higher in group 1 (55.4 vs. 26.9%; p<0.01). Mean injected oocytes per case and fertilization rate in groups 1 and 2 were 7.6 ± 2.4 vs. 7.6 ± 3.0 (p=0.87) and 57.1 vs. 57.9% (p=0.79), respectively. Mean “excellent” (Type A) embryos transferred per case in groups 1 and 2 were 1.7 ± 1.1 vs. 1.8 ± 1.6, (p=0.94), respectively. Implantation, clinical pregnancy and miscarriage rates in groups 1 and 2 were 13.0 vs. 13.3%, (p=0.93), 31.0 vs. 30.4%, (p=0.95) and 15.4 vs. 15.4%, (p=0.46), respectively. Cumulative pregnancy rate per positive sperm retrieval biopsy in groups 1 and 2 were 36.1 vs. 31.3%, (p=0.59), respectively. CONCLUSIONS: Men with NOA have a higher SRR using Microdissection-TESE when compared to TESE. Nevertheless, similar results in ART treatments that use ICSI should be expected when sperm are retrieved. Clinical pregnancy rates of around 30% should be anticipated in this setting, with a cumulative pregnancy rate per positive biopsy of approximately 36%.

Seminal Plasma Lipocalin-Type Prostaglandin D Synthase: A Potential New Marker for the Diagnosis of Obstructive Azoospermia

We examined the relationship between L-PGDS (lipocalin-type prostaglandin D synthase) levels in seminal plasma and the presence or absence of obstruction in the male seminal tract. Semen samples were collected and analyzed from 1) 10 patients with normal semen parameters, 2) 9 with obstructive azoospermia, 3) 20 after vasectomy and 4) 14 with nonobstructive azoospermia. Seminal L-PGDS was measured using an enzyme-linked immunosorbent assay technique. We found that seminal plasma L-PGDS in the groups with obstruction was significantly lower than in any of the other groups (p <0.001). Using a cutoff of 100 microg/l all men with obstructive azoospermia had L-PGDS less than 100 microg/l, while none with normal sperm parameters did. Men with nonobstructive azoospermia had less homogeneity of L-PGDS levels, including 29.6% with L-PGDS more than 100 microg/l. Our results suggest that seminal L-PGDS level can potentially be a biomarker for assessing patency in the seminal tract in men with azoospermia. In men with azoospermia and high seminal L-PGDS (more than 100 microg/l) the diagnosis of nonobstructive azoospermia can be potentially made without biopsy. Our study shows that using semen L-PGDS levels provides a diagnosis of nonobstructive azoospermia in almost 30% of these men.

Influence of a short or long abstinence period on semen parameters in the ejaculate of patients with nonobstructive azoospermia

Objective: To compare the effect of a short (4 days) or a long (14 days) abstinence period on sperm retrieval by extended sperm preparation in patients with nonobstructive azoospermia scheduled for testicular biopsy and intracytoplasmic sperm injection (ICSI). Design: A prospective case control study. Setting: Male infertility clinic in a university hospital. Patient(s): Fifty male patients with nonobstructive azoospermia, scheduled for testicular biopsy for ICSI. Intervention(s): Diagnosis of nonobstructive azoospermia and a thorough microscopic search for sperm cells (extended sperm preparation). Main Outcome Measure(s): The number of sperm cells collected, sperm motility, and total motile sperm count after short and long abstinence periods Result(s): There was a significant difference between long and short abstinence with an increase in sperm count (log-to-log transformed analysis of variance P<.025) and total motile sperm ( P<.025 analysis of variance, P<.02 paired Student’s t-test) in the former group, but no significant change in sperm motility (Wilcoxon and paired Student’s t-test). In 18 patients, sperm concentration and sperm motility were similar in a second collection, done after the same abstinence period, compared with the same parameters in the first sample. When at least 10 motile sperm were defined as the cutoff number, allowing ICSI without testicular biopsy, no significant differences were found between the two abstinence periods. No clinical or laboratory male characteristic could predict the detection of 10 motile sperm by extended sperm preparation either after a short or a long abstinence period. Conclusion(s): Sperm count and total motile sperm were increased after a long abstinence period, with no change in sperm motility. No additional advantages were conferred by long abstinence as opposed to short abstinence when 10 motile sperm were defined as the cutoff number for ICSI. The recommended period of abstinence for extended sperm preparation and ICSI, whether short or long, should be individualized for each patient.