Microdissection testicular sperm extraction in men with Sertoli cell–only testicular histology

Abstract

Objective To study the outcomes of microdissection testicular sperm extraction (microTESE) among men with pure Sertoli cell only histology on diagnostic testicular biopsy. Design Retrospective cohort study. Setting Tertiary referral center. Patients 640 patients with pure Sertoli cell only histology on testicular biopsy who underwent microTESE by a single surgeon. Intervention MicroTESE. Main Outcome Measure Sperm retrieval rates. Results Overall, 44.5% of patients with Sertoli cell-only had sperm retrieved with microTESE. No difference was noted in sperm retrieval rates based on testis volume (≥ 15cc versus <15cc, 35.3% versus 46.1%, respectively). Patients with ≥ 15cc testicular volume and FSH 10-15 mU/mL had the worst prognosis, with a sperm retrieval rate of 6.7%. Conclusions Patients with previous testicular biopsy demonstrating Sertoli cell only histology can be counseled that they have a reasonable likelihood of sperm retrieval with the contemporary delivery of microTESE. Given this finding, the utility of testicular biopsy prior to microTESE is further questioned.

Salvage hormonal therapy after failed microdissection testicular sperm extraction: A multi‐institutional prospective study

“…We used histological results to categorize the patients; however, several patients had immature germ cells according to the embryologists’ reports, indicating a predominant Sertoli cell pattern through histology as opposed to most advanced patterns of spermatogenesis. The SRR in patients with previous testicular biopsies with Sertoli cell‐only histology were 44.5% higher than expected . Furthermore, the SRR of patients with SCO was 0% in the present study, despite the indication that hormonal therapy should be considered based on the cytological results from the embryologists.…”

Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest

“…Clinicians should be aware that men who have normal testicular volume and FSH, with NOA, may have particularly poor SRR outcomes, even with micro-TESE. Interestingly, we additionally identified a similar subgroup of men with Sertoli-cell-only syndrome, in which men with a normal testicular volume and an FSH of 10-15 mU/mL tended to have a lower SRR (12).…”

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

“…The poor relationship between FSH level and spermatogenesis can be explained because FSH secretion and release is controlled by too many endocrine and paracrine factors that ultimately contribute to its serum levels, without ignoring the contribution of the polymorphisms in FSHB genotype and FSHR genotype that may lead to higher than expected FSH levels in some patients [20], so that a linear relationship between FSH serum level and spermatogenesis cannot be expected in all patients. On the other hand, the poor predictive role of testicular volume can be explained by the presence of focal area of intact spermatogenesis that may be found even in patients with testicular atrophy [18,21]. Our data demonstrate that if we would rely on testicular volume to obtain indication for selecting the optimal candidates to surgical sperm retrieval, we would wrongly include and exclude from attempting surgery 32 and 50 % of patients, respectively…”