Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

Abstract

Background Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. Objectives To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). Materials and methods This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Results Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle‐stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Conclusions Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

“…The situation is quite different for the predictive role of serum T on the chances of sperm retrieval, since studies in the field have reported conflicting results. We were able to individuate 14 studies [29][30][31][32][33][34][35][36][37][38][39][40][41][42] who clearly reported the relationship between serum T levels and sperm retrieval rates (SRR) (Table 1). Studies differed for study design, inclusion criteria, and patients' characteristics.…”

“…Seven studies included patients with subnormal presurgical T levels, and six of them [34,37,38,[40][41][42] provided the sperm retrieval rates in patients with low vs. normal T levels. We pooled these latter data to compute the resulting odds ratio (OR), using random-effects models to comply with the high heterogeneity in study design, as detected by I 2 and by Cochran's Q. Computations and forest plot were obtained using Review Manager (RevMan, Version 5.3.…”

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

“…In the past few years, growing interest has been paid to predicting the sperm retrieval rate and pregnancy rates in azoospermic men, who underwent mTESE, but the results remain inconsistent. Çayan et al reported a study that NOA men with a history of cryptorchidism have high sperm retrieval rates with mTESE [ 9 ]. However, some studies have shown that there are no precise and noninvasive methods for predicting whether there are testicular spermatozoa in NOA patients before mTESE [ 10 ].…”

Prediction Models for Successful Sperm Retrieval in Patients with Non-Obstructive Azoospermia Undergoing Microdissection Testicular Sperm Extraction: Is There Any Room for Further Studies?

“…A study utilizing an artificial neural network (ANN) to model the chance of SSR of 1026 men with NOA (770 training set, 256 test set) undergoing microTESE found that cryptorchidism was significant to the model [OR 2.29 (1.47–3.57), p < 0.0001] [ 8 ]. Sperm retrieval rates vary from 52.6% to 75% [ 12 , 13 , 14 , 15 ]. There is no consensus about the predictive ability of age at surgery, side (unilateral vs. bilateral) or testicular volume on SRR.…”

“…Ozan and coworkers evaluated 148 patients with NOA and history of cryptorchidism undergoing mTESE, and found that SSR did not vary with age at surgery (65.1% vs. 55.4% in patients undergoing orchidopexy before or after 10 years of age respectively) or side (62.9% vs. 59.3% in patients, with unilateral of bilateral cryptorchidism, respectively) [ 13 ]. Okada et al found that only testicular volume was predictive of SSR in a cohort of 36 formerly cryptorchid patients with NOA (OR 1.328, 95% CI 1.089–1619, p = 0.045) [ 14 ], while Cayan and collaborators evaluated a cohort of 327 azoospermic men with previous cryptorchidism, and found that SRR was higher in patients with total testicular volume > 13.75 mL (65.3% vs. 45.5%, p = 0.001), serum testosterone > 300.5 ng/dL (65.9% vs. 40.5%), serum FSH level > 17.25 mIU/mL (72.7% vs. 44.3%, p < 0.0001), and age at surgery < 9.5 years (70.8% vs. 42.1%, p < 0.0001) [ 15 ]. Well designed, multicentric studies are warranted to clarify the impact of age at surgery on the chances of SSR of formerly cryptorchid patients with NOA.…”