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

Abstract

SUMMARYSpermatozoa can be retrieved in non-obstructive azoospermia (NOA) patients despite the absence of ejaculated spermatozoa in their semen because of the presence of isolated foci with active spermatogenesis. Conventional testicular sperm extraction (c-TESE) in patients with NOA has been partially replaced by micro-TESE. It is still under debate the problem regarding the higher costs related to micro-TESE when compared with c-TESE. In this study, we evaluated sperm retrieval rate (SRR) of c-TESE in naive NOA patients. Sixty-three NOA patients were referred to our centre for a c-TESE. For every subject, we collected demographic data, cause of infertility, time to first infertility diagnosis, serum levels of LH, FSH, total testosterone and prolactin. A statistical analysis was conducted to correlate all the clinical variables, the histology and the Johnsen score with the SRR. Sixty-three consecutive NOA patients with a mean age of 37.3 years were included. The positive SRR was 47.6%. No statistical differences were observed between positive vs. negative SRR regarding mean FSH (17.12 vs. 19.03 mUI/mL; p = 0.72), and LH (9.72 vs. 6.92 mUI/mL; p = 0.39) values. Interestingly, we found a statistically significant difference in terms of time to first infertility diagnosis (+SRR vs. ÀSRR; 44.5 vs. 57 months; p = 0.02) and regarding to age (+SSR vs. ÀSRR; 40.1 vs. 35.3; p = 0.04). There was a statistically significant decrease in SRRs with the decline in testicular histopathology from hypospermatogenesis to maturation arrest, and SCO. The mean Johnsen score was 5.9 with a mean percentage of Johnsen score ≥8 tubules equal to 19%. The overall pregnancy rate was 26.6%. In our prospective cohort of patients successful SRR with c-TESE was 47.6%. Lower costs and high reproducibility of this technique still support this procedure as an actual reliable option in NOA patients for sperm retrieval.

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

“…The binary logistic regression analysis provided an OR ratio below 1 because histology was computed as categorical variable utilizing HYPO as reference level in contrast coding with SSR as binary dependent value. As a result, when patients' histology differed from HYPO, the chance of SSR decreased, in accordance with the findings of a recent study [22]. Notably, according to the value of +LR ratio, patients with histology different from HYPO were seven times more likely to fail the sperm retrieval procedure.…”

Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review

“…In accordance with the findings of a recent study conducted by Saccà et al. (), when histology result differed from hypospermatogenesis, the likelihood of SSR decreased.…”

Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient

“…This should not be ignored given that a significant number of azoospermic patients are typically affected by secondary disturbances, such hypogonadism, for which mTESE may allow for better preservation of the testicular tissue. On the contrary, other authors have failed to find a significant superiority of mTESE over cTESE in terms of SRRs (9,10). Moreover, the overall positive SRR, lower costs and high reproducibility of cTESE represent unique characteristics that should be taken into account when counseling NOA infertile couples (10).…”

“…On the contrary, other authors have failed to find a significant superiority of mTESE over cTESE in terms of SRRs (9,10). Moreover, the overall positive SRR, lower costs and high reproducibility of cTESE represent unique characteristics that should be taken into account when counseling NOA infertile couples (10). Microdissection TESE, indeed, is a technically challeng-ing and expensive procedure that requires dedicated equipment and specifically trained surgeons.…”