Microdissection testicular sperm extraction: Overall results and impact of preoperative testosterone level on sperm retrieval rate in patients with nonobstructive azoospermia

Abstract

Objective: The main objective is to review the overall result and impact of preoperative testosterone level on sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Materials and Methods: We retrospectively reviewed the files of patients who underwent micro-TESE for NOA from August 2013 to December 2014. All patients were evaluated with history, physical examination, and hormonal assessment. Patients who had previous micro-TESE, obstructive azoospermia, or who took hormone therapy were excluded from the study. Patients were classified into two groups. Group A included patients who had low testosterone (<10 nmol/L), and Group B included patients with normal testosterone (>10 nmol/L). The primary endpoint was to review the overall results of the procedure and the impact of preoperative testosterone level on sperm retrieval. Results: A total of 264 patients with NOA underwent micro-TESE. Group A included 133 patients with low testosterone (<10 nmol/l) with a median age of 36 ± 6.59 years, and Group B included 131 patients with normal testosterone (>10 nmol/L) with a median age of 33 ± 7.88 years ( P = 0.1350). There was no significant difference in follicle-stimulating hormone ( P = 0.2467), luteinizing hormone ( P = 0.1078), prolactin ( P = 0.5619), and testicular volume ( P = 0.4052), whereas a significant difference was found in testosterone level ( P = 0.0001) in both groups. Overall, sperm were successfully retrieved in 48.8% of men. SRR in Group B was significantly higher (57.25%) than that in Group A (40.60%) ( P = 0.0068). SRR in patients with Sertoli-cell-only pathology was 30.35%, hypospermatogenesis was 89.74%, and maturation arrest was 32.43%. Conclusion: Micro-TESE is a successful and safe procedure in NOA patients with a poor prognosis. Preoperative testosterone level has a significant impact in the SRR by micro-TESE.

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.…”

Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

“…Subsequently, Mehmood et al. 61 found a significant correlation between preoperative testosterone levels and the SRR of MD-TESE. Althakafi et al.…”

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

“…Kizilkan et al evaluated 860 patients and found that T levels were predictive of SSR in univariate, but not in multivariate, logistic regression [ 20 ]. On the other hand, Mehmood et al and Çayan et al, evaluating 264 and 327 patients respectively, found that SRR was significantly lower in men with low baseline T levels compared to those with normal baseline T levels (40.6 vs. 57.25, p = 0.0068, and 40.5% vs. 65.9%, p < 0.0001 respectively) [ 15 , 45 ]. Accumulating evidence suggests that higher baseline T levels may be associated with a higher probability of SSR in men with KS [ 26 , 34 ].…”