A comprehensive assessment of predictors of fertility outcomes in men with non-obstructive azoospermia undergoing microdissection testicular sperm extraction

Abstract

Background: Microdissection testicular sperm extraction (microTESE) in men with non-obstructive azoospermia (NOA) is the procedure that results in the highest number of sperm cells retrieved for in vitro fertilization (IVF). This study presents a novel assessment of predictors of sperm retrieval as well as downstream embryology and pregnancy outcomes in cases of men with NOA undergoing microTESE. Methods: A retrospective chart review of 72 men who underwent microTESE for predictors of fertility outcomes including sperm retrieved at microTESE, embryology progression to embryo transfer (ET), clinical pregnancy, live birth, and surplus sperm retrieved for additional IVF/intracytoplasmic injection cycles beyond one initial cycle. Statistical models for each of these outcomes were fitted, with a p-value of < 0.05 considered significant for the parameters estimated in each model. Results: Seventy-two men underwent microTESE, and 51/72 (70.8%) had sperm retrieved. Of those, 29/43 (67.4%) reached ET. Of the couples who underwent ET, 21/29 (72.4%) achieved pregnancy and 18/29 (62.1%) resulted in live birth. Of the men with sperm retrieved, 38/51 (74.5%) had surplus sperm cryopreserved beyond the initial IVF cycle. Age, testicular volume, FSH, and testicular histopathology were assessed as predictors for sperm retrieved at microTESE, progression to ET, pregnancy, live birth, and surplus sperm. There were no preoperative predictors of sperm retrieval, clinical pregnancy, or live birth. Age predicted reaching ET, with older men having increased odds. FSH level had a negative relationship with surplus sperm retrieved. Men with hypospermatogenesis histology had higher rates of sperm retrieval, clinical pregnancy, live birth, and having surplus sperm. Conclusions: Men who underwent microTESE with a hypospermatogenesis histopathology had better outcomes, including higher rates of sperm retrieval, clinical pregnancy, live birth, and having surplus sperm retrieved. Increasing male partner age increased the odds of reaching ET. No other clinical factors were predictive for the outcomes considered.

FSH levels and testicular volumes are associated with the severity of testicular histopathology in men with non-obstructive azoospermia

“…The advent of microTESE significantly improved the odds for these couples to have an opportunity to conceive with autologous gametes. The odds of sperm retrieval with microTESE have been associated with severity of the testicular histopathological architectural pattern in the parenchyma of the testis [8][9][10][11][12][13]. The outcomes of the men in this study were consistent with a significantly higher sperm retrieval rate of 91.7% in men with favorable histopathological patterns as opposed to 56% sperm retrieval rates in the men with unfavorable histopathological patterns.…”

“…The most severe histopathology is Sertoli cell only pattern, characterized by entirely absent germ cells with only Sertoli cells visible in the germinal epithelium by low-power light microscopy. It has been demonstrated that men with more severe histopathological architecture have lower sperm retrieval rates [8][9][10][11][12][13].…”

“…Although a number of studies have examined multiple clinical factors as predictors of microTESE sperm retrieval rates and few have evaluated predictors of fertilization, pregnancy, and live birth rates, this study aims to assess whether there is an association between FSH levels and testicular volumes with the severity of the testicular histopathology in men with NOA [9,10,12,[14][15][16][17][18][19][20][21][22][23][24][25].…”

Comparison of the Effects of Different Testicular Sperm Extraction Methods on the Embryonic Development of Azoospermic Men in Intracytoplasmic Sperm Injection (ICSI) Cycles: A Retrospective Cohort Study

“…Up to now, what these previous studies had in common was a prediction of sperm retrieval rate [ 12 ]. The clinical efficiency of different testicular sperm extractions on the embryo development and clinical pregnancy rates of azoospermic men have been rarely reported.…”

Reproductive Chances of Men with Azoospermia Due to Spermatogenic Dysfunction

“…For predictors of SRR, patient age, serum hormone levels, and testicle size have been evaluated, however, conclusive evidence is lacking that any of these factors is predictive of successful sperm retrieval [ 67 , 68 , 69 ]. Testicular histopathology does provide some prognostic information for SRR, but it is not routinely recommended for diagnosis of NOA, as the diagnosis can be made clinically based on FSH > 7.6 and testis length < 4.5 cm in about 90% of men with this condition [ 22 , 68 , 70 , 71 ]. Similarly, no clinical or biochemical factors have been found to be predictive of ICSI outcomes [ 3 ].…”