Sperm Retrieval Rate Research Articles

Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien–Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. Results: A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33–49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6–22.5) and the total testosterone was 4.6 (3.5–5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien–Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min (p < 0.01). Conclusion: The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE.

Identification of deleterious variants associated with male infertility genes in a cohort of idiopathic hypospermatogenesis patients.

Hypospermatogenesis is a common histopathological subtype of non-obstructive azoospermia and is characterized by a decrease in the total number of germ cells within the seminiferous tubule as a result of spermatogenic failure. Determination of genetic factors before intracytoplasmic sperm injection can prevent the inheritance of these factors, as hypospermatogenesis patients gives high successful sperm retrieval rate. This study aimed to identify the structural variants associated with idiopathic hypospermatogenesis (iHS) by analyzing patient cohorts diagnosed with azoospermia using whole exome sequencing. It is a hospital-based observational study in which patients reporting with azoospermia due to spermatogenic failure were recruited prospectively. Comprehensive clinical history, blood samples, semen analysis parameters, and reproductive endocrine evaluation reports of 51 hypospermatogenesis patients were collected. The known genetic causes were investigated using XY fluorescent in situ hybridization and Yq microdeletion for exclusion. Whole exome sequencing was performed, and the data of 42 iHS patients was analyzed to identify single nucleotide variants associated with diagnostically important male infertility genes. Genomic analysis of SNVs identified rare deleterious candidate variants in CFTR (c.1265C>T; p.Ser422Phe), CYP21A2 (c.955C>T; p.Gln319Glu), SRD5A2 (c.737G>A; p.Arg245Gln), LHCGR (c.378A>C; p.Lys126Asn) and AR (c.2179C>A; p.Arg727Ser) genes associated with 7/42 idiopathic hypospermatogenesis patients. In silico analysis of variants shows deleterious and probably damaging effects on canonical transcripts of the genes. This exploratory genomic analysis conducted on idiopathic hypospermatogenesis patients shows prevalence of rare deleterious candidate variants in genes associated with human male infertility. The candidate variants in idiopathic hypospermatogenesis patients are heterozygous and genotypically associated with syndromic male infertility. The symptomatic heterozygosity leading to mild spermatogenic failure resulting in hypospermatogenesis points towards a multifactorial etiology of the disease. This study justifies the importance of genetic screening of idiopathic hypospermatogenesis patients for the presence of structural variants in known human male infertility genes.

Percutaneous sperm retrieval technique: A reliable and effective sperm retrieval procedure for ICSI in patients with obstructive azoospermia.

To study the reliability and effectiveness of the percutaneous sperm retrieval technique. We retrospectively analyzed the records of 123 consecutive patients with obstructive azoospermia who underwent percutaneous sperm retrieval and intracytoplasmic sperm injection (ICSI) using Percutaneous Epididymal Sperm Aspiration (PESA) with or without a rescue Testicular Sperm Aspiration (TESA). We compared patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed. In addition, the rate of adequate sperm retrieved for ICSI and reproductive outcomes between the groups and literature were compared. The primary outcome was the rate of adequate sperm retrieved for ICSI; the secondary outcomes were reproductive. The successful sperm retrieval was 157 in 157 attempts, with a cumulative sperm retrieval rate of 100%, whether the first or repeated retrieval attempt. The clinical pregnancy rate in patients who had the first sperm retrieval ever and patients who had more than one sperm retrieval performed was 36/108 (33.3%) vs. 15/29 (51.7%) (Pearson chi2(1) = 3.3088; p = 0.085), respectively. Other reproductive outcomes (fertilization rate, cleavage rate, and biochemical pregnancy) were also similar in both groups. PESA associated with or without rescue TESA is a reliable and effective strategy either for retrieving sperm for ICSI, demystifying the concerns about the reliability of repeated PESA, or for reproductive results. This information is reassuring, especially but not exclusively to places with limited resources.

Association of higher serum follicle-stimulating hormone levels with successful microdissection testicular sperm extraction outcomes in nonobstructive azoospermic men with reduced testicular volumes

Abstract To investigate the impact of preoperative serum follicle-stimulating hormone (FSH) levels on the probability of testicular sperm retrieval, we conducted a study of nonobstructive azoospermic (NOA) men with different testicular volumes (TVs) who underwent microdissection testicular sperm extraction (micro-TESE). A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital, Shenzhen, China) were retrospectively reviewed. The subjects were divided into four groups based on average TV quartiles. Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups. Overall sperm retrieval rate was 57.6%. FSH levels (median [interquartile range]) were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was <5 ml (first quartile [Q1: TV <3 ml]: 43.32 [17.92] IU l−1 vs 32.95 [18.56] IU l−1, P = 0.048; second quartile [Q2: 3 ml ≤ TV <5 ml]: 31.31 [15.37] IU l−1 vs 25.59 [18.40] IU l−1, P = 0.042). Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were <5 ml (adjusted odds ratio [OR]: 1.06 per unit increase; 95% confidence interval [CI]: 1.01–1.11; P = 0.011). In men with TVs ≥5 ml, larger TVs were associated with lower odds of sperm retrieval (adjusted OR: 0.84 per 1 ml increase; 95% CI: 0.71–0.98; P = 0.029). In conclusion, elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs <5 ml. In men with TV ≥5 ml, increases in average TVs were associated with lower odds of sperm retrieval.

A Comparative Study of Equatorial and Longitudinal Incision Techniques in Microdissection Sperm Extraction for Nonobstructive Azoospermic Patients.

To compare sperm retrieval rates (SRR), postoperative pain, testicular volume, and postoperative testosterone levels between equatorial incisional microdissection testicular sperm extraction (micro-TESE) and longitidunal incisional micro-TESE in nonobstructive azoospermic (NOA) patients. Fifty NOA patients undergoing equatorial incisional micro-TESE were retrospectively assigned to group 1, while 50 patients undergoing longitidunal incisional micro-TESE were prospectively assigned to group 2. Demographic data, operative time, postoperative pain assessed via the visual analog scale, complications, SRR, and hormonal evaluations (FSH, LH, total testosterone) were recorded. Both groups compared in terms of preoperative demographic and clinical characteristics. SRR, testicular volume and postoperative testosterone, FSH, LH compared between study groups. SRR were significantly higher in group 2 (62%) compared to group 1 (42%) (P=.045). No significant differences in operative time, visual analog scale pain scores, or postoperative complications were observed between groups. Hormonal evaluations showed a statistically significant decrease in testosterone levels for both groups at 3months, but no significant differences between groups. Testicular volume decreased postoperatively in both groups, with no significant differences between them. Longitidunal incisional micro-TESE significantly improves SRR without increasing complication rates compared to equatorial incisional micro-TESE. These findings suggest that the longitidunal incisional micro-TESE may be a valuable advancement in the surgical management of NOA patients, warranting further research and clinical validation.

Predictive Value of Varicocele Grade and Histopathology in Simultaneous Varicocelectomy and Sperm Retrieval in Non-Obstructive Azoospermia: A Retrospective Cohort Study.

Background and Objectives: Varicocele repair in men with non-obstructive azoospermia (NOA) remains a subject of debate due to inconsistent outcomes. This study aimed to evaluate the impact of microsurgical varicocelectomy on sperm recovery rates in men with NOA and to assess the role of varicocele grade and testicular histopathology in predicting postoperative outcomes. Materials and Methods: A retrospective cohort study was conducted of 78 men diagnosed with NOA and clinical varicocele who underwent microsurgical subinguinal varicocelectomy with simultaneous diagnostic and therapeutic testicular biopsy at the Department of Urology of the University of Ioannina between September 2013 and December 2021. Varicoceles were graded I to III based on physical examination and Doppler ultrasound. Histopathological patterns were classified as hypospermatogenesis (HYPO), early maturation arrest (EMA), late maturation arrest (LMA), or Sertoli cell-only syndrome (SCOS). Patients were followed postoperatively at 3, 6, 9, and 12 months, with semen analyses performed according to World Health Organization guidelines to assess sperm presence. Results: At the 12-month follow-up, spermatozoa were detected in the ejaculate of 26 out of 78 patients, resulting in an overall sperm return to ejaculate rate of 33.3%. Varicocele grade significantly influenced outcomes: patients with Grade II varicoceles had the highest sperm return to ejaculate rate (45.2%, 14/31), followed by Grade III (39.1%, 9/23) and Grade I (12.5%, 3/24) (p-value < 0.05). The sperm retrieval rate (SRR) from testicular biopsies also varied with varicocele grade: Grade II had the highest SRR (54.8%, 17/31), followed by Grade III (47.8%, 11/23) and Grade I (33.3%, 8/24). Histopathological findings were significant predictors of sperm retrieval: patients with HYPO had an SRR of 84.8% (28/33) and a sperm return to ejaculate rate of 66.7% (22/33); those with LMA had an SRR of 47.1% (8/17) and a sperm return rate of 23.5% (4/17). No sperm retrieval was observed in patients with EMA (0%, 0/4) or SCOS (0%, 0/24) (p-value < 0.01). Multivariate logistic regression identified varicocele grade and histopathology as independent predictors of sperm retrieval, with higher grades and favorable histopathology associated with increased likelihood of success. Conclusions: Microsurgical varicocelectomy can induce spermatogenesis in a significant proportion of men with NOA, particularly those with higher-grade varicoceles and favorable histopathological patterns such as HYPO or LMA. Varicocele grade and histopathological findings are important predictors of postoperative outcomes and should inform patient selection and counseling. These findings provide valuable insights for optimizing fertility treatments in men with NOA undergoing varicocele repair.

Sperm retrieval, fertilization rates, and clinical outcomes of infertile men with Y chromosome microdeletion: A retrospective cohort study.

In this study, we aimed to explore whether a Y chromosome microdeletion (YCM) confers adverse effects on surgical sperm retrieval potential and intracytoplasmic sperm injection (ICSI) outcomes in men with azoospermia and severe oligospermia. This was a retrospective cohort study, which included infertile men with azoospermia or severe oligospermia who were evaluated for karyotype analysis and YCM testing at a university-affiliated hospital between 2010 and 2022. Outcomes of microdissection testicular sperm extraction (mTESE) for surgical sperm retrieval were compared between men diagnosed with YCM and the control group in which no YCM were found. Additionally, patients from each group who underwent in-vitro fertilization (IVF) - ICSI cycle using ejaculated sperm or surgically retrieved mature spermatozoa were compared regarding their IVF-ICSI cycle outcomes - fertilization rates, cleavage, and blastocyst formation and clinical pregnancy rates. A total of 116 azoospermic and oligospermic men who underwent Y chromosome microdeletion testing were included in the study: 19 men with YCM and 97 controls without YCM. Overall, nine mTESE procedures were performed for patients with YCM and 38 mTESE procedures were done on men from the control group. There were no significant differences between the YCM and control groups in mature sperm retrieval rates (11.1% vs. 26.3% p=0.663), though a trend towards higher rates of findings of elongated and round spermatids as the most mature germ cell was noted in the YCM group (66.7% vs. 28.9%, p=0.054). Out of the 13 men with mature sperm - either ejaculated or surgically retrieved (mTESE) - that had known ICSI cycle outcomes, three men had proven YCMs and 10 controls had no identified YCMs. Basic characteristics were similar between the groups, except for testosterone levels, which were higher in the YCM group (23.0±13.1 vs. 9.4±6.4 nmol/L, p=0.027). Fertilization rates and cleavage rates were similar between the YCM and control groups (42.3% vs. 49.7% and 42.3% vs. 39.3%, p=0.491 and 0.774, respectively). Blastocyst formation rates, and pregnancy rates, while not statistically significant, showed a trend for favorable outcomes in the control group compared to the YCM group (24.1% vs. 7.7%, 72.7% vs. 20.0%, p=0.078 and 0.106, respectively). Y chromosome microdeletion does not affect sperm retrieval rates. Fertilization and cleavage rates are not impaired by microdeletions, while blastocyst formation rates and clinical pregnancy rates per embryo transfer follow a non-significant trend for unfavorable outcomes in the YCM group. Clinical and embryonic development results should be interpreted with caution, as these groups are relatively small.

FertilitY Predictor-a machine learning-based web tool for the prediction of assisted reproduction outcomes in men with Y chromosome microdeletions.

Y chromosome microdeletions (YCMD) are a common cause of azoospermia and oligozoospermia in men. Herein, we developed a machine learning-based web tool to predict sperm retrieval rates and success rates of assisted reproduction (ART) in men with YCMD. Data on ART outcomes of men with YCMD who underwent ART were extracted from published studies by performing a systematic review. This data was used to develop a web-based predictive algorithm using machine learning. FertilitY Predictor classifies the type of YCMD into AZFa, AZFb, AZFc, their combinations, and gr/gr deletions based on the genetic markers as input. Further, it predicts the probability of sperm retrieval, fertilization rate, clinical pregnancy rate, and live birth rate based on the type of YCMD. Validation studies demonstrated its high accuracy and predictability for sperm retrieval, clinical pregnancy rates, and live birth rates. The tool predicts that men with deletions have a chance of sperm retrieval that varies with type of deletions, the clinical pregnancy rates and live birth rates are lower in men with AZF deletions. A trial version of the tool is available at http://fertilitypredictor.sbdaresearch.in . FertilitY Predictor allows users to classify AZFa, AZFb, AZFc, and gr/gr deletions and also predict the outcomes of ART based on the type of deletions. PROSPERO (CRD42022311738).

Efficacy of Surgically Extracted Sperm in Assisted Reproductive Technology

Objectives The objective of this study is to evaluate and compare the efficacy of various sperm extraction techniques used in Assisted Reproductive Technology (ART), focusing on sperm retrieval rates, fertilization rates, and clinical outcomes in patients undergoing fertility treatments. Material and Methods This retrospective observational study was conducted at RISAA IVF, Green Park, New Delhi, from January 2023 to January 2024. The study included male participants diagnosed with azoospermia, who underwent ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Sperm extraction techniques evaluated include percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), and microdissection testicular sperm extraction (micro-TESE). Data were collected from electronic medical records, laboratory reports, and patient charts, focusing on demographic data, sperm retrieval rates, and clinical outcomes. Statistical analysis was performed using SPSS software, with significance set at P &lt; 0.05. Results Surgical sperm retrieval was performed on 11 azoospermic patients. Viable sperm was successfully retrieved using PESA in 18.1% of the patients, while TESA and micro-TESE yielded successful retrievals in 63.6% and 18.1% of the cases, respectively. The overall pregnancy rate achieved through these procedures was 63.6%. No significant difference in pregnancy rates was observed between the different sperm retrieval techniques (P &gt; 0.05). Conclusion The study highlights that PESA, TESA, and micro-TESE are effective sperm extraction techniques for azoospermic patients undergoing ART. The success in sperm retrieval and subsequent pregnancy outcomes underscores the importance of selecting the appropriate method based on individual patient conditions. These findings contribute to the evidence base for optimizing fertility treatments in patients with severe male factor infertility.

Testicular mapping-guided sperm retrieval vs. upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live-birth rates.

Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM. We performed a retrospective cohort study of men with NOA over a 10-year period from 2010 to 2019. The primary outcome was success of SR with secondary outcomes of pregnancy, and live-birth rates. Ninety men were included in the analysis. 60 in the FNAM group in 30 having upfront microTESE. In the FNAM group, 34/60 (56.7%) patients had positive fine needle aspiration (FNA) map for spermatogenesis. Of these 20/31 (64.5%) had FNAM-guided TESA/E, and 11/31 (35.5%) had microTESE. SR was successful in 30 of 31 men (96.8%). Overall SR rate was 54.4% and 56.7% in the FNAM group and upfront microTESE, respectively. There was no statistical difference in SR (P=0.65). The FNAM group had pregnancy and live-birth rates of 42.1% and 36.8%, respectively. The upfront microTESE group had pregnancy and live-birth rates of 36.7% each. χ2 analysis revealed no statistical difference for both pregnancy (P=0.76) and live-birth rates (P=0.75). FNAM carries high predictability and reliability in SR and can be performed prior to microTESE in NOA patients without change in fertility outcomes.

Microdissection testicular sperm extraction outcomes in azoospermic patients post-orchidopexy surgery: A systematic review and meta-analysis.

Cryptorchidism is a common cause of male infertility, often necessitating microdissection testicular sperm extraction (m-TESE) for sperm retrieval post-surgery. However, uncertainties persist regarding m-TESE outcomes and influencing factors following cryptorchidism surgery. A systematic review and meta-analysis were conducted to evaluate sperm retrieval rates (SRR) among patients undergoing m-TESE after cryptorchidism surgery. Factors including age at orchidopexy, age at m-TESE, type of cryptorchidism, serum hormone levels, testicular volume, and interval from surgery to m-TESE were analyzed for their impact on SRR.Nine studies encompassing 935 patients were included. The overall SRR was 57% (95% confidence interval [CI] 51% to 63%). Compared to patients with negative sperm retrieval (SR-), patients with positive sperm retrieval (SR+) underwent m-TESE at an older age (1.81 years; 95% CI 1.17 to 2.45) and orchidopexy at a younger age (-3.35 years; 95% CI -6.34 to -0.36). Different types of cryptorchidism (including high scrotal, inguinal canal, intra-abdominal) significantly influenced SRR (P<0.05). Serum testosterone, follicle-stimulating hormone, luteinizing hormone levels and testicular volume showed no significant correlation with SRR (P>0.05). Furthermore, SR- patients typically experienced shorter intervals from orchidopexy to m-TESE compared to SR+ patients (34.09 months; 95% CI 0.40 to 67.77). Earlier orchidopexy and much later m-TESE procedures, as well as undescended testis closer to the scrotum, increase the likelihood of successful sperm retrieval. Orchidopexy for cryptorchidism should be done as early as possible, whether it is performed before 18 months of age or detected at a much older age. In patients with undetected cryptorchidism and azoospermia after puberty, m-TESE should not be performed immediately after orchidopexy, the optimal interval from orchidopexy to m-TESE still requires further study.

Microscopic Testicular Sperm Extraction in Patients with Klinefelter Syndrome: Long-Term Outcomes from a Single Center

Objective: Klinefelter syndrome (KS) represents a sex chromosome anomaly observed in approximately 1 in 500–600 phenotypic males. It is observed in 3% of infertile males and up to 11.9% of azoospermic males. KS manifests in either non-mosaic (47, XXY) or mosaic (47, XXY/46, XY) forms, with 85% of cases presenting as the non-mosaic 47, XXY karyotype. The average rate of surgical sperm retrieval in patients with KS is around 50%, ranging from 28% to 69%. In this study, we aimed to present the outcomes of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic KS. Materials and Methods: The results of 61 patients diagnosed with KS, who presented to the Harran University Urology Clinic with azoospermia between 2017 and 2024, were retrospectively reviewed. Hormonal assessments, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and total testosterone (TT), were conducted for all patients, and their partners underwent gynecological evaluations for infertility. Testicular dimensions were recorded via scrotal ultrasonography. Patients were categorized into TESE-positive and TESE-negative groups, and parameters were compared between these groups. Results: The mean age of the patients was 29.0±5.1 years, and their mean infertility duration was 5.9±4.1 years. The sperm retrieval rate was 29.5% (n=18). Mean levels of FSH, LH, prolactin, estradiol, and TT were 44.9 IU/L, 23.3 IU/L, 10 nmol/L, 31.4 pmol/dL, and 219 ng/dL, respectively. Sperm was retrieved in 18 patients (29.5%), while no sperm was obtained in 43 (70.5%). No significant correlation was observed between patient age, testicular size, serum levels of FSH, LH, prolactin, estradiol, and TT, and sperm retrieval rates when comparing the TESE-positive and TESE-negative groups (P&gt;0.005). Conclusion: In patients with non-mosaic KS, hormonal parameters, age, and infertility duration were not found to be significant predictors of the success of micro-TESE in sperm retrieval.

Future prospects for the advancement of treatment of men with NOA: focus on gene editing, artificial sperm, stem cells, and use of imaging.

Nonobstructive azoospermia (NOA) affects about 60% of men with azoospermia, representing a severe form of male infertility. The current approach to manage NOA primarily involves testicular sperm retrieval methods such as conventional testicular sperm extraction (c-TESE) and microdissection testicular sperm extraction (micro-TESE). While combining testicular sperm retrieval with intracytoplasmic sperm injection (ICSI) offers hope for patients, the overall sperm retrieval rate (SRR) stands at around 50%. In cases where micro-TESE fails to retrieve sperm, limited options, like donor sperm or adoption, can be problematic in certain cultural contexts. This paper delves into prospective treatments for NOA management. Gene editing technologies, particularly clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) protein 9 (CRISPR/Cas9), hold potential for correcting genetic mutations underlying testicular dysfunction. However, these technologies face challenges due to their complexity, potential off-target effects, ethical concerns, and affordability. This calls for research to address key challenges associated with NOA management within the clinical settings. This also necessitate ongoing research essential for developing more sensitive diagnostic tests, validating novel treatments, and customizing current treatment strategies for individual patients. This review concluded that the future of NOA management may entail a combination of these treatment options, tailored to each patient's unique circumstances, providing a comprehensive approach to address NOA challenges.

A Nomogram Predicting Testicular Sperm Extraction Success in Men With Non-obstructive Azoospermia: A Multi-center Study

ObjectivesTo develop an efficient and easy-to-use nomogram which can predict testicular sperm extraction(TESE) success in men with non‐obstructive azoospermia(NOA) by using pre-operative parameters. Materials and MetodsData of 3093 men who underwent TESE for NOA were included in this study. Demographic data, testis volumes, presence of varicocele, length of infertility, history of previous surgeries, history of genitourinary infections, smoking status, chromosome abnormalities, presence of Y-chromosome microdeletion, family history of infertility, testis biopsy, surgical data, sperm retrieval rate, final pathology obtained at testicular sperm extraction, follicle stimulating hormone, luteinizing hormone, testosterone levels were recorded. The primary outcome was to develop an efficient nomogram which can predict the TESE success in men with NOA. The secondary outcomes were identifying the significant pre-operative parameters which are associated with success in TESE. ResultsSperm retrieval rate was 50.2%(1553/3093). Testis volume, history of varicocelectomy, chromosome abnormalities, presence of Y-chromosome microdeletion were shown to affect sperm retrieval rate significantly(p<0.05). Sperm retrieval success was higher in men with older age, higher testis volume(>10mL), lower follicle stimulating hormone level(≤ 12.92mIU/mL), lower luteinizing hormone level, and higher testosterone level(p<0.05). Only testis volume and patient’s age were associated with succesful sperm retrieval in multivariate logistic regression analysis. ConclusionIn men with NOA, high testis volume, old age, low follicle stimulating hormone level, low luteinizing hormone level, and high testosterone level are advantageous for successful sperm retrieval in TESE. Herein we present a nomogram which can predict the outcome of TESE in men with NOA with adequate success.

Successful Sperm Retrieval and Clinical Pregnancies Following Micro-TESE and ICSI Treatments in Patients with Nonobstructive Azoospermia Due to Various Etiologies.

(1) Background: Nonobstructive azoospermia (NOA) etiologies affect the sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) and the clinical outcomes following intracytoplasmic sperm injection (ICSI); (2) Methods: We investigated seven NOA etiologies. The SRR and clinical outcomes of 627 patients were analyzed between November 2017 and July 2022 in the Reproductive and Genetic Hospital of China International Trust and Investment Corporation-Xiangya (CITIC-Xiangya); (3) Results: The overall SRR was 39.4% (247/627). The SRR according to NOA etiologies were: Y chromosome azoospermia factor c microdeletions (26/46, 56.5%), Klinefelter syndrome (KS), 36/85, 42.4%), idiopathic (110/398, 27.6%), cryptorchidism (20/29, 69.0%), chromosome anomalies (7/13, 53.9%), orchitis (45/50, 90.0%), and cancer (3/6, 50.0%). The SRR were different for spermatogonia arrest (26/96, 27.1%), maturation arrest (76/177, 42.9%), and SCOS (30/80, 37.5%) according to histological examinations. The clinical pregnancy rate was similar among the NOA etiologies. The high-quality embryo rate differed between successful (54.7%) and unsuccessful (40.9%) pregnancies. Moreover, the successfully pregnant women (28.99 years) were younger than the unsuccessfully pregnant ones (30.92 years); (4) Conclusions: The SRR from patients with NOA was associated with the etiology and histological categories, while the clinical outcome was associated with the high-quality embryo rate and the female partner's age.

The effect of intratesticular autologous platelet-rich plasma injection on sperm retrieval rates and in vitro fertilization outcomes in couples with non-obstructive azoospermia.

To assess the efficacy of intratesticular injection of autologous platelet-rich plasma (PRP) in men with non-obstructive azoospermia (NOA) and a history of failed microdissection-testicular sperm extraction (mTESE) procedures. A prospective case series of a cohort study was conducted involving couples diagnosed with NOA. Patients with at least one failed mTESE procedure were included. Intratesticular PRP injection was performed using a standardized protocol. Follow-up assessments included sperm analysis, hormonal evaluation, and in vitro fertilization (IVF) outcomes. Data from 177 men with NOA were analyzed, with 135 patients meeting eligibility criteria. PRP treatment resulted in positive sperm retrieval rates of 27.5% in patients with one prior failed mTESE procedure and 16.4% in patients with two or more failed attempts. IVF outcomes showed fertilization rates of 86.4% and 100.0% in respective groups, with pregnancy rates of 36.8% and 22.2% per embryo transfer. Histopathological examination post-mTESE revealed varied patterns, including Sertoli cell-only syndrome and maturation arrest. Intratesticular PRP injection shows promise as a potential therapeutic approach for NOA patients with prior failed mTESE procedures, demonstrating improved sperm retrieval rates and favorable IVF outcomes. Further randomized controlled trials are warranted to validate these findings and refine the technique's efficacy in male infertility management to answer the question of whether PRP could significantly improve the second attempt retrieval rate.

(074) OFFICE-BASED MICRODISSECTION TESTICULAR SPERM EXTRACTION FOR NONOBSTRUCTIVE AZOOSPERMIA RESULTS IN HIGH SPERM RETRIEVAL RATES

Abstract Introduction Microdissection testicular sperm extraction (microTESE) is performed in men with nonobstructive azoospermia who desire sperm retrieval for use in IVF. This procedure can be performed in the operating room or in the clinic with local analgesic. Objective To report office-based microTESE sperm retrieval, fertilization, and livebirth rates. Methods A review was conducted of all patients who underwent office-based microTESE for nonobstructive azoospermia with a partner that who underwent concurrent oocyte retrieval for an intended in-vitro fertilization (IVF) intracytoplasmic injection (ICSI) cycle 2022-2024. All male partners underwent Y chromosome microdeletion testing, karyotype analysis, and hormonal testing preoperatively. Patients with a diagnosis of hypogonadism were offered medical therapy and those diagnosed with a varicocele were offered varicocelectomy prior to microTESE. Office-based microTESE was performed using a surgical operating microscope, spermatic cord block, and oral anxiolytic. Female partners underwent oocyte retrieval with oocyte cryopreservation prior to microTESE. Oocyte warming and ICSI was performed only following the collection of motile sperm from the fresh microTESE samples. Relevant demographic and clinical data were collected for patients and their partners. Descriptive data analysis was performed and reported as mean ± standard deviation. Results Ten patients underwent 11 office-based microTESE procedures. One patient had repeat microTESE following an unsuccessful IVF/ICSI cycle. Overall sperm retrieval rate was 70% for first time microTESE with mean search time 197.2 ± 96.5 min. Amongst couples with successful sperm retrieval, normal fertilization rate was 42%. Early cleavage arrest was seen in 84% of normally fertilized oocytes with a 16% blastocyst rate. Embryo development arrested entirely in two couples, while the remaining five couples had at least one blastocyst on day 5 and underwent embryo transfer. Of these, four resulted in a clinical pregnancy (36%). Three couples had a successful live birth and one has an ongoing pregnancy with ultrasound-confirmed fetal heartbeat. Conclusions Our small series demonstrates high sperm retrieval rates from office-based microTESE. Fertilization rates, clinical pregnancies and live birth rates are comparable with those reported in the literature. Given the financial cost associated with microTESE and IVF/ICSI for nonobstructive azoospermia patients, office-based microTESE may be a solution to make the process more financially accessible for couples. Disclosure No.

(263) IS THERE STILL A ROLE FOR TESTICULAR FINE NEEDLE ASPIRATION MAPPING IN THE TESTICULAR MICRODISSECTION ERA?

Abstract Introduction Finding sperm in men with non-obstructive azoospermia (NOA) can be challenging. Over the years, reproductive urologists have used a number of different strategies to maximize sperm retrieval rates and the testicular microdissection (mTESE) has been crowned the winner. Objective Some urologists perform testicular fine needle aspiration mapping (TFNA mapping) despite the fact that mTESE is the sperm retrieval surgery of choice. Why is this? The present investigation investigated the role of TFNA mapping in the present era. Methods We obtained from the “Find an SSMR Doctor” section of the Society for The Study of Male Reproduction (SSMR) email addresses of fellowship-trained male reproductive urologists and sent to them an 8-question survey. We queried the clinician’s attitudes toward TFNA mapping and how, if at all, this procedure fits into their own practices. Results Out of 96 surveys sent, we received a total of 32 responses (33% response rate). Of the 32, only 10 had any experience whatsoever with TFNA mappings. 6/10 reported that they currently used TFNA mapping with 4/10 respondents reporting that they used to use it but no longer do. Reasons cited for abandoning mapping included poor results (50%), limited or no access to a laboratory for interpretation (25%), and other (25%). The 6 clinicians that currently used TFNA mapping answered subsequent follow-up questions regarding their usage. If mapping failed to find any sperm at all, then urologists were split 50/50 on either referring for donor sperm or proceeding to mTESE. If mapping found rare sperm only then the majority of respondents proceeded to targeted TESE (75%) as opposed to mTESE (25%). In the event that a mapping resulted in copious amounts of sperm, 75% of clinicians indicated that they would proceed to testicular sperm aspiration as opposed to standard TESE (75% vs 25%). 100% current users of TFNA mapping found that the information gained from the procedure was valuable when counseling patients with non-obstructive azoospermia. Conclusions The mTESE is a difficult operation that requires a high level of andrology and embryology support that is simply outside the reach of many urologists that practice male reproductive urology. In contrast, the TFNA mapping is quick and easy to perform. The present study, with all its obvious limitations, demonstrates that some fellowship trained male reproductive urologists utilize TFNA mapping and find it helpful. Urologists that use mapping can avoid mTESE for their patients in certain situations and use the information gained from mapping to guide further management. The survey also indicates that inadequate access to quality laboratories for interpretation is an impediment to TFNA mapping usage. Disclosure No.

Secondary azoospermia after a successful natural pregnancy: a primary prospective study

BackgroundTo date, there is a lack of studies conducted on males with secondary azoospermia as a potential cause of male infertility who had previously fathered children through natural conception. The current study aims to investigate the potential causes of secondary azoospermia as a presentation of male infertility as well as the prognostic factors that can impact sperm retrieval rate (SRR) while undergoing microdissection testicular sperm extraction (microTESE).ResultsThirty two patients were recruited from the andrology outpatient clinic from August 2023 till January 2024. The mean age of the patients was sixty-two years old. All patients had varicoceles. Twenty seven patients (84%) had palpable varicocele grade 2 and 3 on both sides. Further multivariate logistic regression analysis of the significant factors in the univariate regression revealed that younger age (OR 0.7, 95% C.I. 0.7-1.0, p = 0.03) and having a history of coronary artery disease (CAD) were predictable factors for negative TESE outcome (OR 123.1, 95% C.I. 3.2-4748.5, P = 0.01).ConclusionIt appears that the etiopathogenesis of secondary azoospermia are multifactorial. Varicocele and CAD are major factors to be considered. Future studies should be implemented deploying larger pools of patients suffering from the same condition to affirm the findings of this primary study.

Clinical predictors of successful outcomes for couples with nonobstructive azoospermic male partners undergoing micro-TESE.

Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.