Micro‐testicular sperm extraction outcomes for non‐obstructive azoospermia in a single large clinic in Victoria

Abstract

Aims To evaluate the results of microdissection testicular sperm extraction (micro‐TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non‐obstructive azoospermia (NOA). Materials and methods We retrospectively analysed data of 88 consecutive patients with clinical NOA who were treated with micro‐TESE by a single surgeon, between August 2014 and September 2020, in Melbourne, Victoria. Upon a successful sperm retrieval, sperm was either used fresh for ICSI, frozen for future use or both. The outcome measures were sperm retrieval rate (SRR), and in vitro fertilisation (IVF)/ICSI results. Furthermore, SRR was calculated for the predominant causes and histopathological patterns. Results The overall SRR was 61.2%. It was significantly higher in patients with a history of cryptorchidism and other childhood diseases (100%) than in the other NOA groups (P < 0.05). Patients with Klinefelter syndrome had a 75% SRR. Among the different types of testicular histology, the highest SRR were noted in patients with complete hyalinisation (100%) and hypospermatogenesis (92.9%), and low with Sertoli cell‐only syndrome (46.3%). The SRR has significantly increased from 33.3% in 2015–2016 to 73.6% in 2019–2020 (P = 0.009). Of the 52 patients with SSR, 47 underwent IVF/ICSI. Fertilisation rate was 42.4%. Twenty‐nine couples achieved at least one good‐quality embryo and had embryo transfer. Nineteen achieved pregnancy (40.4%), and in three patients a miscarriage resulted. Conclusions This is the first report from Australia showing that micro‐TESE is an effective treatment for NOA with high SRR. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.

A case of 49,XXXYY followed-up from infancy to adulthood with review of literature

“…However, it is unlikely that this patient's father has SCA, as his parents had two children born by natural conception. While the number of successful pregnancies with the partners of men with KS is increasing, these are usually achieved by in vitro fertilization [17,18]. It is difficult for the partners of men with KS to experience natural pregnancies.…”

Surgical management of male infertility: An overview

“…54 For example, sperm may still be found using microTESE in up to 47% of cases where a biopsy showed Sertoli-only cells, a condition formerly thought to be a strong negative predictor for successful sperm retrieval. 55 In non-obstructive azoospermia, retrieval of sperm from the testes is the only option. Both the AUA 2021 and EAU 2022 guidelines recommend the use of microTESE over cTESE given the superior sperm retrieval rates, lower risk of causing iatrogenic hypogonadism, lower volume of testicular tissue removed and lower complication rates of haematoma and fibrosis (Table 3).…”

Klinefelter Syndrome: What should we tell prospective parents?

“…Given the relatively high success rate for sperm retrieval for adults with KS, current evidence suggests that delaying invasive procedures is still to be recommended. 53,64 Discussion in late adolescence around potential options for sperm retrieval and consultation with an endocrinologist or andrologist should be offered, to allow for planning for future WHITE ET AL. fertility preservation.…”

“…Furthermore, testicular biopsy during adolescence may have the effect of damaging an already abnormal testis, thereby reducing the chances of future success at a time when fertility is actually desired. Given the relatively high success rate for sperm retrieval for adults with KS, current evidence suggests that delaying invasive procedures is still to be recommended 53,64 . Discussion in late adolescence around potential options for sperm retrieval and consultation with an endocrinologist or andrologist should be offered, to allow for planning for future fertility preservation.…”

“…50 Only a single case report outlines a natural conception with a man with KS, 51 but it is unknown if further cases exist in undiagnosed KS cases. Although males with KS have traditionally been described as infertile, evolving in vitro fertilisation (IVF) techniques of intra-cytoplasmic sperm injection (ICSI) and micro-testicular sperm extraction (micro-TESE) have been associated with successful sperm retrieval in up to 75% of men, 52,53 with an increasing number of successful pregnancies over time 54,55 without risk of KS transmission to the foetus. 55 Fertility in KS should be discussed in the context of infertility rates in the general population, which approximate 15%.…”