Testis spectroscopy may predict sperm retrieval rate in men with non-obstructive azoospermia undergoing micro-TESE: A pilot study

Abstract

Objective: To investigate whether prior testis magnetic resonance spectroscopy predicts the success or failure of micro-dissection testicular sperm extraction (micro-TESE) in patients with non-obstructive azoospermia (NOA). Material and Methods: Nine men with NOA who were scheduled for micro-TESE for the first time, 9 NOA men with a history of previous micro-TESE and 5 fertile men were enrolled. All NOA patients and fertile controls underwent testis spectroscopy. A multi-voxel spectroscopy sequence was used. Testicular signals of choline (Cho), creatine (Cr), myo-inositol (MI), lactate, and lipids were analyzed quantitatively and compared with the results of the micro-TESEs. Results: The most prominent peaks were Cho and Cr in the fertile controls and NOA subjects with positive sperm retrieval in the micro-TESE. A high Cho peak was detected in 87% of the NOA men with positive sperm retrieval. NOA men without sperm at the previous micro-TESE showed a marked decrease in Cho and Cr signals. For positive sperm retrieval in micro-TESE, the cutoff value of Cho was 1.46 ppm, the cutoff value of Cr was 1.43 ppm, and the cutoff value of MI was 0.79 ppm. Conclusion: Testis spectroscopy can be used as a non-invasive screening method to predict the success or failure of micro-TESE.

Evaluation from a different perspective of 10‐year results of infertile males with Y chromosome AZFc microdeletions compared with a control group

“…It was observed that the presence of p/cAZFc deletions was not a positive or predictive factor before m‐TESE. This 46 XY with no AZF deletion was also concordant with any strong predictive factor in all azoospermia prior to surgery (Celik et al, 2019; Corona et al, 2019; Gnessi et al, 2018). Our oocyte fertilisation rate in all AZFc deletions was 39% which was aligned with the other series (Corona et al, 2019; Sabbaghian et al, 2018).…”

When to ask for an MRI of the scrotum

“…An increase in glutamate also has been observed in NOA testes with failed sperm retrieval. 97,105,108 Furthermore, recently testicular fat deposition was measured using the fat fraction map of mDIXON Quant sequence in middleaged overweight patients, including infertile and normal population. 109 The technique proved a reliable tool for the measurement of testicular fat deposition, enabling an accurate diagnosis and monitoring of male infertility.…”

“…Total choline represents a reliable predictor for the detection of NOA, with a cutoff of 0.616 mmol/kg to differentiate between NOA and normal testes. 97,105,108 Testicular lipids represent the most useful discriminating metabolite in the characterization of the histologic subtype of NOA. Increase in lipid peaks is seen in NOA testes with presence of foci of advanced spermatogenesis up to the haploid gamete stage.…”

Ovarian stimulation drugs alter the metabolite content of the growing follicle: in vivo spectroscopic evaluation of follicle fluid

“…As soon as the follicle diameters reached 16-18 mm in each group, patients underwent MRS and the metabolite content of a dominant follicle was analyzed. N-acetylaspartate (NAA), lactate (Lac), creatine (Cr), and choline (Cho) metabolite levels were measured in the spectra in ppm ( 10 , 12 ).…”

“…NAA, Lac, Cr, and Cho peaks of each group were analysed. A detailed discussion of these spectroscopic methods can be found elsewhere ( 6 , 7 , 8 , 9 , 12 ). The primary outcome of this study was to investigate the effects of rFSH, CC and AI treatment on dominant follicle metabolite levels, in terms of NAA, Lac, Cr and Cho.…”