Testicular Sperm Extraction With Intracytoplasmic Sperm Injection for Nonobstructive Azoospermia: Testicular Histology Can Predict Success of Sperm Retrieval

Abstract

Critical examination of the most advanced pattern of spermatogenesis from open diagnostic testis biopsy allows prediction of sperm retrieval success with testicular sperm extraction. In this study population spermatozoa were retrieved in 58% of attempts. When this testicular sperm was used with intracytoplasmic sperm injection, clinical pregnancy rate was 55% for men with nonobstructive azoospermia.

Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection

“…Histology re-reviews were performed prospectively, and were blinded to the original pathologic diagnosis. For the study, a third independent review summarized the written findings from the two readings and assessed each of the following: [1] specimen adequacy (Ͼ25 seminiferous tubule cross-sections) (7), [2] presence or absence of fixation artifact (vacuole formation due to air-drying or fixation in formalin, or specimen overstaining or understaining), and [3] biopsy pattern.…”

“…The criteria for a clinically significant change include the following: [1] a change from normal to any abnormal pattern (i.e., change in presumed etiology from obstructive to nonobstructive azoospermia); [2] a change from any abnormal pattern to a normal pattern (i.e., change in presumed etiology from nonobstructive to obstructive azoospermia); [3] any pure pattern diagnosis without mature sperm (i.e., EMA, SCO) changed to a pure or mixed pattern that suggests presence of mature sperm (i.e., HYP or normal); and [4] any mixed pattern diagnosis without mature sperm (i.e., EMA, SCO) changed to a pure or mixed pattern that suggests mature sperm is present (i.e., HYP or normal).…”

“…For example, in cases of Sertoli cell-only (germ cell aplasia) pathology, successful sperm retrieval occurs in 5% to 60% of cases (3)(4)(5)(6). Although this may reflect differences in surgical technique among individuals and centers that specialize in male infertility care, we hypothesize this variation may also stem from inconsistent interpretation of biopsy histology by pathologists.…”

“…In men with nonobstructive azoospermia, clinical features including testicular size, history of ejaculated sperm, serum follicle stimulating hormone level, or testis biopsy histology do not accurately predict whether sperm will be recovered during testicular exploration (2). However, among these variables, successful testicular sperm retrieval is most closely related to the type or pattern of spermatogenic defect observed on testicular biopsy (3).…”

Tissue-specific differentially methylated regions of the human VASA gene are potentially associated with maturation arrest phenotype in the testis

“…Diagnostic biopsies included the evaluation of more than 100 sections per biopsy of seminiferous tubules per biopsy. 24,25 Testicular histology was classified into hypospermatogenesis (reduction in the degree of normal spermatogenic cells), maturation arrest (MA) (lack of late stage of spermatogenesis), Sertoli cell-only syndrome(lack of germ cells in seminiferous tubules) and tubular sclerosis (no germ cell or Sertoli cell present in the seminiferous tube). 26 Isolation of total RNA and genomic DNA All of the testicular tissue specimens obtained from biopsy were used for the isolation of total RNA and testicular genomic DNA.…”