Clinical Comparison of Conventional Testicular Sperm Extraction and Microdissection Techniques for Non-Obstructive Azoospermia

Abstract

BackgroundWe compared the efficacy of microdissection testicular sperm extraction (microdissection TESE) and conventional TESE in patients with non-obstructive azoospermia (NOA) and related the positive sperm recovery to certain variables: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, testicular volume and histology.MethodsSperm retrieval rates (SRR) in patients with NOA who underwent microdissection TESE (n = 65) or conventional TESE (n = 68) were compared and related to the different variables.ResultsSRR by microdissection TESE (56.9%) was significantly higher than conventional TESE (38.2%). There was a positive relation between the SRR and increased testicular volume or decreased FSH levels. No effect of Testosterone or Prolactin levels on SRR by using either technique was observed. Sperm were recovered from those with hypospermatogenesis in 84% and 92.9% by conventional and microdissection TESE, respectively (P = 0.3). In cases of maturation arrest the SRR was 27.3% and 36.4%, respectively (P = 0.6). In cases of Sertoli-cell-only syndrome (SCOS) the SRR was 6.2% and 26.9%, respectively (P = 0.03). No major operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism.ConclusionsMicrodissection TESE significantly had twice better probability of success of SRR when compared to conventional TESE. No secure pre-operative prognostic elements of sperm recovery exist for NOA patients. Microdissection TESE appears to be recommendable in cases of atrophied testicles, high FSH concentration, or when SCOS with high FSH concentration can be predicted.KeywordsMicrodissection TESE; Sperm retrieval; Non-obstructive azoospermia; Histopathology; FSH concentration; Orchidometry

Conventional testicular sperm extraction (TESE) and non‐obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non‐academic community hospital

“…16.7 (n = 24) 37.5 (n = 8) 6.3 (n = 16) 44.6 (n = 74)* 75 (n = 12) 33.9 (n = 56)* Tsujimura et al, 2002 35.1 (n = 37) 76.9 (n = 13) 0 (n = 1) 13 (n = 23) 42.9 (n = 56) 100 (n = 12) 75 (n = 4) 22.5 (n = 40) Ramasamy et al, 2005 32 (n = 83) 50 (n = 14) 20 (n = 10) 29 (n = 24) 57 (n = 460)* 81 (n = 73)* 44 (n = 62) 41 (n = 237) Ghalayini et al, 2011 38.2 (n = 68) 84 (n = 25) 27.3 (n = 11) 6.2 (n = 32) 56.9 (n = 65)* 92.9 (n = 28) 36.4 (n = 11) 26.9 (n = 26)* *Statistically significant (p < 0.05).…”

“…In the literature, four studies (Okada et al, 2002;Tsujimura et al, 2002;Ramasamy et al, 2005;Ghalayini et al, 2011) directly compared SRRs between c-TESE and micro-TESE, relating to histopathology findings (SCOS and MA). The hypospermatogenesis was studied in three out of the four manuscripts (Table 4).…”

The poly(A)-binding protein genes, EPAB, PABPC1, and PABPC3 are differentially expressed in infertile men with non-obstructive azoospermia

“…Therefore, this analysis may not have reflected histopathologic status of the whole testis of the infertile men. Consistently, it has been shown that multiple biopsy samples from different parts of the testis resulted in sperm retrieval in patients with azoospermic testis and even in the patients with SCO in certain cases [40,41]. As a result, since obtaining testicular biopsy materials from one part of human testis cannot represent histopathologic status of the whole testis, it may affect the accuracy of findings.…”

Multiple needle‐pass percutaneous testicular sperm aspiration as first‐line treatment in azoospermic men

“…However, in a number of studies on mTESE a biopsy for histology is only obtained during the surgical sperm retrieval thereby excluding the prognostic value of histopathological diagnosis (Tsujimura et al, 2002;Ramasamy et al, 2005;Turunc et al, 2010;Ghalayini et al, 2011). For example, in a study by Ramasamy et al (2005) histopathological diagnosis was known from prior biopsies in some patients, whereas the other patients had a biopsy taken during the surgical sperm retrieval.…”

“…As a result and because of the relatively high SRR and low reported complication rates (Schlegel, 1999;Amer et al, 2000;Okada et al, 2002;Tsujimura et al, 2002;Ramasamy et al, 2005;Turunc et al, 2010;Ghalayini et al, 2011) many centers use mTESE as the first choice of retrieving spermatozoa in NOA. However, this global approach does not allow for individualized treatment based on the patients needs.…”