Predictors for sperm retrieval in microdissection sperm extraction for non-obstructive azoospermia

Abstract

formulations. 42 (48.3%) used cutaneous testosterone gels, while 23 (26.4%) used testosterone injections. 49 (56.3%) respondents found their patients to be satisfied ''most times'' and 30 (34.5%) said their patients are ''almost always'' satisfied with Testopel therapy. When Testopel therapy was discontinued, cost was cited as the most common reason.CONCLUSIONS: Testopel implantation appears to be a highly successful therapy for the treatment of hypogonadism. This study categorizes common practices that have yet to be standardized. Based on this specialty society questionnaire, management of hypogonadism may require 10 or more pellets in the majority of cases.

A risk prediction model of sperm retrieval failure with fine needle aspiration in males with non-obstructive azoospermia

“…serum FSH level, testicular volume and age, each having a correlation with the testicular sperm retrieval rate (Carpi, et al , 2009, Turunc, et al , 2010, Cissen et al , 2016). However, it is notable that FSH was found not to be correlated with the sperm acquisition rate in a retrospective study including 1275 patients with NOA using micro-TESE combined with ICIS (Ishikawa, et al , 2015). It is possible that in most micro-TESE series with fully detailed dissections, small, focal areas of sperm production can be found that may be missed with FNA.…”

Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia

“…In addition, they obtained cutoff points of 400 ng/mL for total testosterone and 11 pg/mL for free testosterone with predictive accuracies of 37.7% and 35.5%, respectively. By contrast, the majority of studies analyzed both total and free levels of serum testosterone in the aforementioned groups of patients did not corroborate this statistically significant difference between the groups and therefore have concluded that serum testosterone lacks any value in predicting sperm retrieval rate by TESE operation [14,18,19,23,27,30]. Moreover, in reports which proposed testosterone as a predictive biomarker, serum testosterone level either acts as a part of a multivariate model or lacks sufficient sensitivity and specificity required for clinical application.…”

“…Similarly, Bonarriba et al [25] have introduced the cutoff point of 12.2 mIU/mL for serum FSH with sensitivity and specificity of 71% and 75%, respectively. Nevertheless, it is generally accepted that the serum FSH has a poor value for predicting the existence of sperm in the testes [27,28,30]. Indeed, cases with even serum FSH > 90 mIU/mL but positive TESE outcomes have been observed in previous studies [21].…”

“…Most studies that investigated serum LH concentration with TESE outcome have found no significant difference in LH levels between patients with and without successful TESE outcome and hence did not consider any predictive value for serum LH level [12,14,18,23,27,30]. By contrast, Cetinkaya et al [16] have reported significantly lower levels AUC area under the curve, NA not available or applicable *Between groups of men with positive and negative sperm retrieval § Including patients with both obstructive and non-obstructive azoospermia † Surprisingly, higher values were significantly associated with greater chance of sperm recovery of serum LH in men with positive sperm retrieval compared to those with negative sperm retrieval.…”

“…However, the results of the latter study, notwithstanding their salience, should be interpreted cautiously due to the existence of significant limitations in that study: Firstly, relatively small sample size and secondly, the exclusion of diverse groups of men with respect to NOA etiology makes it difficult to generalize its findings to the population of NOA patients. In fact, it has been indicated that men with various causes of NOA such as AZFa or AZFb microdeletion, and Klinefelter syndrome have significantly different chances of successful sperm recovery by TESE [27]. Therefore, the inclusion of men with various etiologies of NOA in the study of Alfano et al could alter the sperm retrieval rate by mTESE surgery and thereby influence its association with the concentration of circulating AMH.…”