Efficacy of the second micro–testicular sperm extraction after failed first micro–testicular sperm extraction in men with nonobstructive azoospermia

Özman, Oktay; Tosun, Süleyman; Bayazit, Numan; Cengiz, Sami; Bakircioglu, M.E.

doi:10.1016/j.fertnstert.2020.10.005

Cited by 19 publications

(25 citation statements)

References 20 publications

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“…Among them, three studies were excluded for unavailable data on potential predictors, 15,30,31 another three studies were excluded because their surgical history did not meet the inclusion criteria, that is, multiple TESEs or other procedures such as TESA or testicular biopsy prior to salvage mTESE, 3,32,33 and one study had a successful mTESE followed by salvage surgery 34 . A total of seven retrospective case–control studies were identified as eligible in this meta‐analysis, four of which included 332 NOA patients who underwent a failed initial mTESE, 9,12,14,35 and three of which included 177 NOA patients who underwent a failed cTESE 23,36,37 . The characteristics of the included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies containing 76 SR + patients and 208 SR − patients were involved in the analysis of the association between infertility duration and salvage mTESE after a failed mTESE 11,13,14 . As shown in Figure 2B, there was no significant heterogeneity ( I 2 = 0%, p = 0.621), and the pooled results did not show the predictive value of infertility duration on the outcome of salvage mTESE (SMD: −0.26, 95% CI: −0.53 to 0.01, p > 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…However, the SRR of mTESE still hovers at approximately 50%, which means that almost half of patients with NOA cannot obtain spermatozoa for further intracytoplasmic sperm injection (ICSI) during the initial mTESE 8 . Fortunately, it has been demonstrated that patients with NOA who have suffered from a failed mTESE can still undergo salvage mTESE procedures to obtain spermatozoa up to 3 months after the initial procedure, 9 with an SRR of approximately 12.5%–79.2% 10–15 . However, the procedures of former mTESE may damage testicular tissue and disrupt the blood supply of the tunica albuginea, leading to fibrosis, hematoma, and even testicular atrophy, which would make sperm retrieval much more difficult in salvage surgery 16 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non‐obstructive azoospermia: A systematic review and meta‐analysis

et al. 2023

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BackgroundThere has been no systematic review and meta‐analysis to analyze and summarize the predictive factors of successful sperm extraction in salvage microdissection testicular sperm extraction.ObjectivesWe aimed to investigate the factors predicting the result of salvage microdissection testicular sperm extraction in patients with non‐obstructive azoospermia who failed the initial microdissection testicular sperm extraction or conventional testicular sperm extraction.Materials and methodsWe conducted a systematic literature search in PubMed, Web of Science, EMBASE, and the Cochrane Library for literature that described the characteristics of patients with non‐obstructive azoospermia who underwent salvage microdissection testicular sperm extraction after failing the initial microdissection testicular sperm extraction or conventional testicular sperm extraction published prior to June 2022.ResultsThis meta‑analysis included four retrospective studies with 332 patients with non‐obstructive azoospermia who underwent a failed initial microdissection testicular sperm extraction and three retrospective studies with 177 non‐obstructive azoospermia patients who underwent a failed conventional testicular sperm extraction. The results were as follows: among non‐obstructive azoospermia patients whose first surgery was microdissection testicular sperm extraction, younger patients (standard mean difference: −0.28, 95% confidence interval [CI]: −0.55 to −0.01) and those with smaller bilateral testicular volume (standard mean difference: −0.55, 95% CI: −0.95 to −0.15), lower levels of follicle‐stimulating hormone (standard mean difference: −0.86, 95% CI: −1.18 to −0.54) and luteinizing hormone (standard mean difference: −0.68, 95% CI: −1.16 to −0.19), and whose testicular histological type was hypospermatogenesis (odds ratio: 3.52, 95% CI: 1.30–9.53) were more likely to retrieve spermatozoa successfully, while patients with Sertoli‐cell‐only syndrome (odds ratio: 0.41, 95% CI: 0.24–0.73) were more likely to fail again in salvage microdissection testicular sperm extraction. Additionally, in patients who underwent salvage microdissection testicular sperm extraction after a failed initial conventional testicular sperm extraction, those with testicular histological type of hypospermatogenesis (odds ratio: 30.35, 95% CI: 8.27–111.34) were more likely to be successful, while those with maturation arrest (odds ratio: 0.39, 95% CI: 0.18–0.83) rarely benefited.ConclusionWe found that age, testicular volume, follicle‐stimulating hormone, luteinizing hormone, hypospermatogenesis, Sertoli‐cell‐only syndrome, and maturation arrest were valuable predictors of salvage microdissection testicular sperm extraction, which will assist andrologists in clinical decision‐making and minimize unnecessary injury to patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non‐obstructive azoospermia: A systematic review and meta‐analysis

et al. 2023

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“…This was not statistically significant, but is an observation that certainly would warrant study in a larger trial prior to acceptance into clinical practice. A recent retrospective publication by Ozman et al [3] that cited an 18.4% successful sperm retrieval rate following repeat microTESE without any medical intervention, demonstrating the lack of clarity for these difficult scenarios and questioning whether the findings of Verdi et al would hold true in a larger study population.…”

Section: Gonadotropinsmentioning

confidence: 98%

Medical management of male infertility: now and future

Chen

Kathrins

Ohlander

et al. 2022

Current Opinion in Urology

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Purpose of reviewMedical therapy for idiopathic male infertility has historically been empiric and based on small observational studies rather than larger well designed clinical trials. This review is timely and relevant because of the recent publication of several studies that are less susceptible to bias because of being placebo-controlled and more highly powered.Recent findingsThe largest proportion of recent publications covered antioxidants, with eight randomized controlled trials (RCTs) included in this review. The Males, Antioxidants, and Infertility (MOXI) trial is of particular interest, being a large multicenter RCT, which demonstrated no improvement in semen parameters or live-birth rates with antioxidant use. In addition, phosphodiesterase-5 inhibitors (PDE5i) have been shown to improve semen parameters, while duloxetine use was not associated with any adverse effects on sperm. Progress was also made in the realm of regenerative medicine, with the realization of the first successful primate model of sperm production from pluripotent stem cells.SummaryIt may be time to stop recommending antioxidants for idiopathic male infertility given recent studies suggesting lack of efficacy, but given their relative safety, it is reasonable to continue their use until the evidence is overwhelming. Otherwise, stem cell therapy is another anticipated area of research interest.

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“…For men who undergo initial microTESE in which no sperm are retrieved, there is no consensus on how to proceed. To explore the viability of repeat microTESE, Ozman et al [30 ▪ ] published a multiinstitutional retrospective review of 125 men who underwent repeat microTESE after initial procedure failure. Men who had testosterone <300 nanograms per deciliter received hormonal optimization prior to repeat procedure.…”

Section: Nonobstructive Azoospermiamentioning

confidence: 99%

Modern surgical treatment of azoospermia

Brant¹

2022

Current Opinion in Urology

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Purpose of reviewTo review noteworthy research from the last 2 years on surgical management of azoospermia.Recent findingsThe recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue.SummaryMost men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification.

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Efficacy of the second micro–testicular sperm extraction after failed first micro–testicular sperm extraction in men with nonobstructive azoospermia

Cited by 19 publications

References 20 publications

Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non‐obstructive azoospermia: A systematic review and meta‐analysis

Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non‐obstructive azoospermia: A systematic review and meta‐analysis

Medical management of male infertility: now and future

Modern surgical treatment of azoospermia

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