Effects of age, testicular volume, reproductive hormone, and testicular biopsy on sperm retrieval rate of micro-TESE in NOA patients with AZFc deletion

doi:10.21203/rs.3.rs-1960052/v1

Download PDF

Research Article

Effects of age, testicular volume, reproductive hormone, and testicular biopsy on sperm retrieval rate of micro-TESE in NOA patients with AZFc deletion

https://doi.org/10.21203/rs.3.rs-1960052/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objective: To investigate whether age, testicular volume, reproductive hormone, and preoperative diagnostic testicular biopsy affected sperm retrieval rate (SRR) in individuals with non-obstructive azoospermia (NOA).

Patients and methods: Retrospective analysis of clinical data of NOA patients with AZFc deletion who had microdissection testicular sperm extraction (micro-TESE). The effects of age, testicular volume, FSH, LH, T, and preoperative diagnostic testicular biopsy on SRR were compared cross-sectionally in this group of patients.

Results: A total of 181 individuals had their sperm successfully collected and underwent micro-TESE, with an SRR of 67.4 %. The results of micro-TESE were separated into two groups: sperm acquisition and non-sperm acquisition, with no significant variations in age, testicular volume, FSH, LH, and T between the two groups. Binary logistic regression explored the absence of significant effects of age, testicular volume, FSH, LH, and T on sperm acquisition in patients undergoing micro-TESE. Based on whether or not a preoperative diagnostic testicular biopsy was conducted, the above parameters were compared between the two groups. Testicular volume was higher in the group with preoperative diagnostic testicular biopsy than in the group without preoperative diagnostic testicular biopsy, while FSH and T were lower. In the preoperative testicular diagnostic biopsy group, the sperm acquisition and non-acquired sperm groups had SRR of 90.1 % and 65.1 %, respectively, with the sperm acquisition group being significantly higher than the non-acquired sperm group.

Conclusion: There is a high probability of successful sperm acquisition in the testis with micro-TESE. In this group of patients, age, testicular volume, FSH, LH, and T may have little bearing on the micro-TESE outcome. In patients whose preoperative diagnostic testicular biopsy revealed no sperm, the probability of obtaining sperm by micro-TESE remained high (65.1%), while negative preoperative diagnostic testicular biopsy results appeared to not influence SRR by micro-TESE.

AZFc deletion

non-obstructive azoospermia

micro-TESE

testicular biopsy

sperm retrieval rate.

Up to 30% of male infertility is due to spermatogenic dysfunction caused by genetic abnormalities, particularly severe male infertility such as azoospermia and severe oligospermia[1]. Klinefelter syndrome is the most frequent genetic cause of male infertility, followed by azoospermia factor (AZF) deletion on the Y chromosome. The incidence of AZF deletion is about 4% in the general population and 10–15% in azoospermia[2]. Azoospermia is the most devastating kind of infertility in men. They can only have genetic babies through intracytoplasmic sperm injection (ICSI), which involves surgically extracting mature sperm from the testes. Infertile couples can, of course, abandon surgical therapy in favor of donor sperm.

Testicular sperm extraction can be done using a variety of surgical techniques. Both testicular sperm aspiration (TESA) and micro-TESE are frequently employed in clinical treatment, and each has its own set of benefits and drawbacks. It is critical to evaluate not just the surgical success rate, but also the patient's financial situation, the risk of complications, and medical history while making clinical treatment decisions. TESA involves percutaneous aspiration of testicular tissue to obtain sperm, which is minimally invasive but somewhat blind, as the area of high-quality spermatogenesis may be unevenly distributed, resulting in a low number or poor quality of sperm retrieved, or even failure[3]. Micro-TESE has a greater SRR than TESA and conventional TESE, however the latter takes a longer process time and is more expensive[4].

The hypothalamic-pituitary-testicular axis controls spermatogenesis, which is a complicated process. As a result, any of the hormones involved in this axis, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) might affect proper spermatogenesis. Other relevant factors, such as body mass index, prolactin, and estradiol, were found to not influence most studies and were thus excluded from our study[5].

Non-invasive markers, such as the patient's age, testicular volume, and reproductive hormone levels, as well as invasive indicators, such as testicular biopsy and testicular pathology reports, are useful for NOA patients planning to undergo micro-TESE[6, 7]. These can assist clinicians and infertile couples in making the best clinical decision possible. However, the measurements' predictive usefulness is unclear, and while micro-TESE has been promoted as the gold standard for sperm retrieval in males with NOA, its superiority to conventional TESE is controversial[8, 9].

We retrospectively analyzed data from our center to investigate the effects of age, testicular volume, reproductive hormones, and preoperative diagnostic testicular biopsy on sperm recovery after micro-TESE in patients with NOA due to AZFc deletion. The goal was to guide the clinical management of patients with NOA due to AZFc deletion and provide more appropriate clinical therapies.

Patients

From January 2015 to December 2019, clinical data on age, testicular volume, reproductive hormones, and preoperative diagnostic testicular biopsies, as well as clinical outcomes of sperm found intraoperatively, were collected in NOA patients with AZFc deletion who underwent micro-TESE at our Center for Reproductive Medicine. For the analysis, the average volume of both tests was employed (Testometer used to measure bilateral tests). If the patient only had one, only one testicle was utilized in the calculation. Ours is a retrospective single-center study. Different types were categorized cross-sectionally. Patients who met the criteria below were excluded:1) previous varicocele; 2) cryptorchidism; 3) history of radiotherapy; 4) Klinefelter or Kallman syndromes; 5) hypothalamic/pituitary defects; 6) taking medications that affect hormone levels were excluded from the study (e.g., exogenous testosterone, selective estrogen receptor modulators, gonadotropins, or aromatase inhibitors).

According to the European Academy of Andrology (EAA) and the European Molecular Genetics Quality Network (EMQN) guidelines for molecular diagnosis of Y-chromosomal microdeletions, a total of eight loci were examined for sY14 (SRY), ZFX/ZFY, sY84, sY86, sY127, sY134, sY254, and sY255, of which both sY254 and sY255 were lacking as AZFc deletion[10]. All of the patients were tested for the AZF gene and were clinically diagnosed with AZFc deletion, as well as chromosomal karyotyping to rule out chromosomal abnormalities.

Patients were divided into groups based on preoperative indicators. Based on age, they were divided into 2 groups, < 30 years and ≥ 30 years; Based on the mean testicular volume, they were divided into 3 groups, < 6 mL and ≥ 6 mL. According to FSH levels, they were divided into 3 groups, < 11.1 mIU / mL, 11.1–22.2 mIU / mL, and ≥ 22.2 mIU / mL, respectively; According to the LH level, they were divided into 2 groups, ≤ 6.8mIU/mL and ≥ 6.8mIU/mL, respectively; According to T levels, they were divided into 3 groups, < 8 nmol/L, 8–12 nmol/L, and ≥ 12 nmol/L, respectively.

Methods

The clinical diagnosis was non-obstructive azoospermia and AZFc deletion based on the patient's history, physical examination, and pertinent laboratory testing. Before the operation, the patient had at least three times semen analyses, and after centrifugation, no sperm were discovered on microscopic examination. Before the operation, patients masturbate once more to gather semen for evaluation. Before microscopic sperm extraction, no sperm are detected in the semen, and if sperm is found in the semen, the procedure is canceled. Patients and their families were given information regarding surgery alternatives and risks, as well as informed consent forms to complete. Each patient had venous blood samples obtained after an overnight fast (7 am to 11 am). A chemiluminescent immunoassay was used to quantify T (reference range = 9.45–37.45 ng/ml), luteinizing hormone (reference range = 0.63–11.70 mIU/ml), and follicle-stimulating hormone (reference range = 0.96–11.55 mIU/ml).

Procedures

Some patients willingly choose to get TESA before micro-TESE, and depending on the results, they decide between micro-TESE and getting sperm from a sperm bank as their next course of therapy. The patient is placed in a lying position, the doctor will disinfect the skin in the perineal area with iodine and then apply local anesthesia with lidocaine. The skin of the scrotum is taut because one testicle is fixated by hand. The surgeon next inserts a piercing needle into the testis and pushes it back and forth to extract the testicular tissue. A sample of testicular tissue was placed in a culture medium, shipped to the lab to be ground, and then inspected under a microscope to check for the presence of spermatozoa to learn more about testicular spermatogenesis. Histological analysis was done in another section. Although TESA may find sperm, the patient decides to proceed with micro-TESE to ensure that enough sperm is recovered for ICSI the next time due to the insufficient number and quality of sperm.

The surgical procedure of micro-TESE is referred to in the previous article published by Schlegel et al[11]. A longitudinal incision is made in the middle of the scrotum, the skin and sheath are incised, and the testes and epididymis are exposed and extruded. Under an operating microscope (S88, Carl Zeiss, Germany) with a maximum magnification of 18x, the albuginea was incised along the middle transverse surface of the testis with a sharp blade, and the testicular parenchyma was carefully dissected layer by layer with miniature forceps. The relatively full and thick spermatogenic tubules were chosen, put in a Petri plate, and delivered right away to the embryo laboratory staff. During the operation, two senior laboratory staff members use a 1 mL syringe needle to slice, tear and separate testicular tissue to release spermatogenic cells and sperm from the germinal tubules to make a cell suspension that is searched for under a microscope for mature sperm. If enough sperm are detected in sufficient number and with good morphology, the surgery is completed. If no sperm can be found in one testicle, the adjacent testicle is incised and inspected thoroughly at the same time. Interrupted 5 − 0 silk sutures are used to seal the incision in the white membrane. The surgical incision was closed, the testis was moved back into the sheath, and the scrotum was bandaged tightly. When no spermatozoa were discovered intraoperatively in a patient, the obtained germinal tubules were maintained in culture for 24 hours before another sperm search was conducted. If no sperm were still discovered, the germinal tubules were then cultured. In the absence of sperm, the culture fluid was centrifuged and the search for sperm was repeated.

Statistics

For the statistical work, we used IBM SPSS Statistics version 25.0 (IBM Corporation, Armonk, NY, USA). The data were subjected to descriptive statistical analysis (median as well as an interquartile range). To see if the non-normally distributed data differed between groups, the Wilcoxon test was performed. The variations in SRR between groups were compared using the Chi-square test and Fisher’s exact test. A statistical difference is indicated by a p < 0.05.

A total of 181 NOA patients with AZFc deletion underwent micro-TESE, with 122 obtaining sperm during the treatment, resulting in an SRR of 67.4% (122/181). We compared baseline data on age, testicular volume, and serum reproductive hormones in patients in the micro-TESE sperm acquisition group (n = 122) and the no sperm found group (n = 59). There were no significant differences between the two groups in terms of age, testicular volume, FSH, LH, and T, as shown in Table 1 and Fig. 1. Age, testicular volume, reproductive hormones, and whether preoperative diagnostic testicular biopsy was performed as independent variables, and whether micro-TESE obtained sperm as dependent variables, yielded OR of 1.01, 0.99, 0.96, 1.09, 1.02, 0.70, respectively, with no significant effects in the binary logistic regression analysis, as shown in Fig. 2. The SRR was separated into subgroups based on age and reproductive hormone levels, and the differences in SRR between subgroups were compared. The SRR of patients aged 30 years and > 30 years in the two groups were compared, 68.2% and 66.7%, respectively, with no difference between the groups; the SRR of the groups with serum FSH levels < 11.1 mIU/ml, 11.2–22.2 mIU/ml and ≥ 22.2 mIU/ml, 75.0%, 67.0,% and 61.2%, respectively, with no difference between the groups; the SRR of the groups with serum T levels < 8 nmol/L, 8–12 nmol/L and ≥ 12 nmol/L SRR, 66.1%, 65.8,% and 71.4%, respectively, with no difference between groups; SRR in the groups with serum LH levels < 6.8 mIU/ml and ≥ 6.8 mIU/ml, 64.4% and 70.3%, respectively, with no difference between groups. Table 2 displays the results. The SRR of the final micro-TESE did not differ significantly across the groups, whether they were divided by age over 30 years or by reproductive hormone level.

Table 1

Patient baseline characteristics and comparison of age, testicular volume and reproductive hormone between two groups.
Characteristics	All patients (n = 181)	Group1 (n = 122)	Group2 (n = 59)	p
Age(year), median(IQR)	30 (28–33)	30 (28–33)	30 (27–33)	0.797
Testicular volume(ml), median(IQR)	8 (6–12)	9 (7–12)	9 (7–11)	0.764
FSH(mIU/ml), median(IQR)	16.50 (11.10–16.50)	16.30 (10.70-22.13)	16.80 (11.80–24.20)	0.444
LH(mIU/ml), median(IQR)	6.80 (5.04–9.60)	6.95 (5.22–9.68)	6.47 (4.62–9.55)	0.365
T(nmol/L), median(IQR)	9.60 (7.68–12.45)	9.62 (7.70-12.55)	9.50 (7.38–11.60)	0.651
Group1: Sperm obtained during micro-TESE; Group2: No sperm obtained during micro-TESE; IQR: interquartile range; FSH: Follicle-stimulating hormone; LH: Luteinizing hormone; T: Testosterone.

Table 2

Comparison of SRR between two groups.
Subgroups	Group1 (n = 122)	Group2 (n = 59)	SRR	p
Age, n
< 30 year	58	27	68.2%
≥ 30 year	64	32	66.7%	0.82
Testicular volume, n
< 6 ml	30	17	63.8%
≥ 6 ml	92	42	68.7%	0.54
FSH, n
< 11.1 mIU/ml	33	11	75.0%
11.1–22.2 mIU/ml	59	29	67.0%
≥ 22.2 mIU/ml	30	19	61.2%	0.16
T, n
< 8 nmol/L	37	19	66.1%
8–12 nmol/L	50	26	65.8%
≥ 12 nmol/L	35	14	71.4%	0.56
LH, n
< 6.8 mIU/ml	58	32	64.4%
≥ 6.8 mIU/ml	64	27	70.3%	0.40
Group1: Sperm obtained during micro-TESE; Group2: No sperm obtained during micro-TESE; FSH: Follicle-stimulating hormone; LH: Luteinizing hormone; T: Testosterone; SRR: Sperm retrieve rate

We regrouped 181 NOA patients with AZFc deletion into two groups: those who had a preoperative testicular diagnostic biopsy (n = 65) and those who did not have a prior testicular diagnostic biopsy (n = 116). The differences in age, testicular volume, FSH, LH, and T between the two groups were compared, and it was found that the testicular volume was greater in the group without preoperative diagnostic testicular biopsy (10 ml vs. 8 ml, p = 0.002), but FSH was lower (14.7 mIU/ml vs. 17.9 mIU/ml, p = 0.018) and T was lower (9.12 nmol/L vs. 10.3 nmol/L, p = 0.025). Table 3 and Fig. 3 show the results.

Table 3

Comparison of age, testicular volume and reproductive hormone between two groups.
Characteristics	Group1 (n = 116)	Group2 (n = 65)	p
Age(year), median(IQR)	30 (27–33)	30 (28–33)	0.518
Testicular volume(ml), median(IQR)	8 (6–10)	10 (8–12)	0.002
FSH(mIU/ml), median(IQR)	17.9(12.20–23.90)	14.7 (11.80–20.40)	0.018
LH(mIU/ml), median(IQR)	6.95 (4.84–9.82)	6.71(5.06–8.12)	0.476
T(nmol/L), median(IQR)	9.12 (7.05–12.2)	10.3 (8.65–12.60)	0.025
Group1: No testicular biopsy before micro-TESE; Group2: Testicular biopsy before micro-TESE; FSH: Follicle-stimulating hormone; LH: Luteinizing hormone; T: Testosterone; IQR: interquartile range.

65 patients in our study had diagnostic testicular aspiration biopsy, during which testicular tissue was obtained for pathological examination, and some patients had intraoperative microscopy in conjunction with diagnostic testicular aspiration biopsy, during which a portion of the testicular tissue was torn apart and spermatozoa were searched for under a microscope. Based on the results of the testicular biopsy, we split the patients into two groups. In postoperative testicular histological sections or intraoperative microscopy, 22 patients had mature spermatozoa visible, while 43 patients had no spermatozoa visible. Only two of the 22 patients who underwent further micro-TESE failed, with an SRR of 90.1%. In contrast, 43 patients received later micro-TESE surgery, with 28 of them achieving a success rate of 65.1%, a significant difference between the two groups (p = 0.036). Table 4 shows that there was no statistically significant difference in SSR between the preoperative testicular diagnostic biopsy group and the non-preoperative testicular diagnostic biopsy group (73.9% vs. 63.8%, p = 0.166).

Table 4

Comparison of SRR between two groups.
Factors	Group1 (n = 122)	Group2 (n = 59)	SRR	p
No testicular biopsy, n	72	42	63.8%
Testicular biopsy, n	48	17	73.9%	0.166^#
Obtain sperm, n	28	15	65.1%
No obtain sperm, n	20	2	90.1%	0.036^*
Group1: Sperm obtained during micro-TESE; Group2: No sperm obtained during micro-TESE; SRR: Sperm retrieve rate
# Testicular biopsy vs. No testicular biopsy; * No obtain sperm vs. Obtain sperm.

The major treatment choices for NOA patients are micro-TESE. Due to its better sperm acquisition rate and lower testicular injury, micro-TESE has emerged as the gold standard for testicular sperm retrieval in patients with non-obstructive azoospermia. However, it requires a specialized operating microscope and a microsurgeon with specialized training.

AZFc deletion, the second most frequent genetic factor in NOA, is quite common in NOA patients[12]. Non-invasive indicators such as age, testicular size, and reproductive hormones, as well as invasive testicular biopsies, are important in determining the spermatogenic function of the testes before micro-TESE and can assist clinicians and infertile couples in making the best clinical decisions for them[13]. A study suggested that spermatogenic function declines with age in patients with AZFc deletion and that early assisted reproduction or sperm freezing is recommended for patients with AZFc deletion[14]. However, our study focused on NOA patients with AZFc deletion, and the results showed that age did not affect SRR by micro-TESE. The findings of Caroppo et al. demonstrated that testicular volume and FSH did not affect SRR in NOA patients, which is consistent with the findings of this study[15]. Our findings reveal that, while the sperm acquisition rate reduced as FSH levels increased, there was no statistically significant difference between groups. Sertoli-only cell syndrome accounted for 46% of testicular pathology in 178 AZFc deletion patients from 19 studies, inhibited maturation for 38%, and hypospermatogenesis for 16%, according to a systematic review of testicular pathology in 178 AZFc-deletion patients from 19 studies[16]. According to our clinical experience, spermatogenic function in the testes of patients with AZFc deletion is extremely heterogeneous, and the testes may contain three different pathological tissue types at the same time, so a simple testicular pathological examination is rarely representative of the actual spermatogenic situation of the entire testis. The SRR for azoospermia patients with AZFc deletion who underwent fine needle aspiration (FNA) for sperm extraction was 34.7% (17/49), according to a study conducted at our center[17]. In this study, the SRR was 67.4% (122/181) in 181 individuals with AZFc deletion NOA, nearly twice as high as that of traditional sperm retrieval via TESA. When comparing the sperm acquired and unobtained sperm groups, the preoperative testicular diagnostic biopsy group had an SRR of 90.1% and 65.1%, respectively. Even though micro-TESE had a better chance of finding sperm in patients with sperm identified in a preoperative testicular biopsy, roughly 10% of patients still failed to discover sperm satisfactorily. Micro-TESE, on the other hand, has a higher likelihood of discovering mature sperm in patients whose preoperative testicular biopsy did not reveal sperm than in the average patient, hence the predictive utility of using preoperative testicular biopsy pathology results for subsequent micro-TESE is limited. For patients with NOA due to AZFc deletion, we advocate direct micro-TESE to maximize the likelihood of detecting sperm intraoperatively, get a sufficient number and quality of sperm for ICSI-assisted conception and minimize extra testicular tissue damage caused by testicular biopsy.

According to the relevant literature we reviewed, this study focused on NOA patients with AZFc deletion, and it had the largest number of cases in this patient category in a single-center study. Our findings indicate that the micro-TESE treatment is a high-SSR sperm retrieval strategy for patients with AZFc-deletion NOA, which is in line with the findings of most research[18, 19]. Furthermore, we discovered that age, testicular volume, serum FSH, LH, and T levels in AZFc-deletion NOA patients may have little bearing on the micro-TESE outcome. Eken et al. found results that were similar to ours[20]. The Meta-analysis found that neither serum FSH nor testicular volume predicted SRR in micro-TESE, with testicular pathology biopsy being the greatest predictor, confirming our findings[21]. However, NOA patients with elevated FSH (including those with Klinefelter syndrome) were shown to have a greater SRR in micro-TESE, indicating active spermatogenesis in the testis[22]. The mean testicular volume of men without sperm retrieval in micro-TESE in NOA patients was 5.7 ml, which was lower than the sperm acquisition group, suggesting that a smaller testicular volume is linked to more severe spermatogenic damage[23]. This discrepancy in results could be due to various study populations or differing micro-TESE sperm retrieval success rates at different medical sites. Even with small testes, areas of normal spermatogenesis may exist, and more research is needed to confirm this in the evaluation of predictors.

The presence of tubules with spermatozoa in a diagnostic testicular biopsy conducted before micro-TESE was found to be the strongest predictor of positive surgical sperm retrieval in patients with NOA[24]. This supports our findings that a preoperative diagnostic testicular biopsy detecting sperm improves SRR of micro-TESE. Our findings also revealed that patients who underwent micro-TESE without preoperative diagnostic testicular biopsy had a nice SRR (63.8%), with no significant difference from the preoperative diagnostic testicular biopsy group, implying that preoperative diagnostic testicular biopsy may not be necessary. In our study, some patients (n = 22) with positive testicular biopsies had a negative final micro-TESE (n = 2), which accounted for 9.09%. This could be because the testicular tissue along the needle path would have been severely damaged during the puncture, which could explain why some patients with positive testicular biopsies had negative final micro-TESE[25]. Despite the benefits of the TESA, which is minimally invasive and rapid, studies have shown that postoperative problems such as postoperative hemorrhage, hematoma development, and infection can impair the micro-TESE outcome[26].

We performed a cross-sectional observational study to analyze clinical data from patients with AZFc-deletion NOA who underwent micro-TESE. Our findings imply that age, testicular volume, FSH, LH, and T levels in AZFc-deletion NOA patients getting micro-TESE did not affect the outcome. Although preoperative diagnostic testicular biopsy appears to be a poor predictor of SSR, patients with no sperm found in preoperative diagnostic testicular biopsy still have a high chance of obtaining sperm by micro-TESE, and clinicians should consider a combination of AZFc-deletion NOA patients to provide maximum clinical benefit to their patients.

AZF

azoospermia factor

EAA

European Academy of Andrology

EMQN

European Molecular Genetics Quality Network

FNA

fine needle aspiration

FSH

follicle-stimulating hormone

ICSI

intracytoplasmic sperm injection

luteinizing hormone

micro-TESE

microdissection testicular sperm extraction

NOA

non-obstructive azoospermia

SRR

sperm retrieval rate

testosterone

TESA

testicular sperm aspiration.

Acknowledgments

Not applicable.

Funding information

No funding or grants were provided for this study.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflict of interest Disclosures

No conflicts of interest are declared.

Author’s contribution statement

The study was designed by DCY and MJM. Data collection was conducted by ZLM, LDF, LHC, ZZ, YYZ, and ZHT. The text was written by DCY and MJM, while the statistical analysis was done by DCY. Administrative and technical support was supplied by ZZ, HK, and JH. This investigation is overseen by JH. The final manuscript was read and approved by all writers.

Consent for publication

Not applicable.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were by the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Review Committee of Reproductive Medicine of Peking University Third Hospital, China (No. 2020SZ-001). Written informed consent was obtained from all patients prior to the commencement of the study. All patient information was anonymized and de-identified before analysis.

Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clinical biochemistry. 2018;62:2–10.
Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo, Brazil). 2013;68 Suppl 1(Suppl 1):15–26.
Godart ES, Turek PJ. The evolution of testicular sperm extraction and preservation techniques. Faculty reviews. 2020;9:2.
Alkandari MH, Moryousef J, Phillips S, Zini A. Testicular Sperm Aspiration (TESA) or Microdissection Testicular Sperm Extraction (Micro-tese): Which Approach is better in Men with Cryptozoospermia and Severe Oligozoospermia? Urology. 2021;154:164–9.
Pavan-Jukic D, Starc A, Stubljar D, Jukic T. Obesity with High Body Mass Index Does Not Influence Sperm Retrieval in Males with Azoospermia. Medical science monitor: international medical journal of experimental and clinical research. 2020;26:e923060.
Maglia E, Boeri L, Fontana M, Gallioli A, De Lorenzis E, Palmisano F, et al. Clinical comparison between conventional and microdissection testicular sperm extraction for non-obstructive azoospermia: Understanding which treatment works for which patient. Archivio italiano di urologia, andrologia: organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2018;90(2):130–5.
Rohan P, Daly N, O'Kelly A, O'Leary M, Dineen T, Shah N, et al. Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia. Journal of reproduction & infertility. 2021;22(2):103–9.
Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, et al. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Human reproduction update. 2019;25(6):733–57.
Esteves SC, Ramasamy R, Colpi GM, Carvalho JF, Schlegel PN. Sperm retrieval rates by micro-TESE versus conventional TESE in men with non-obstructive azoospermia-the assumption of independence in effect sizes might lead to misleading conclusions. Human reproduction update. 2020;26(4):603–5.
Krausz C, Hoefsloot L, Simoni M, Tüttelmann F. EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: state-of-the-art 2013. Andrology. 2014;2(1):5–19.
Stahl PJ, Masson P, Mielnik A, Marean MB, Schlegel PN, Paduch DA. A decade of experience emphasizes that testing for Y microdeletions is essential in American men with azoospermia and severe oligozoospermia. Fertility and sterility. 2010;94(5):1753–6.
Peña VN, Kohn TP, Herati AS. Genetic mutations contributing to non-obstructive azoospermia. Best practice & research Clinical endocrinology & metabolism. 2020;34(6):101479.
Gnessi L, Scarselli F, Minasi MG, Mariani S, Lubrano C, Basciani S, et al. Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC urology. 2018;18(1):63.
Golin AP, Yuen W, Flannigan R. The effects of Y chromosome microdeletions on in vitro fertilization outcomes, health abnormalities in offspring and recurrent pregnancy loss. Translational andrology and urology. 2021;10(3):1457–66.
Caroppo E, Colpi EM, Gazzano G, Vaccalluzzo L, Scroppo FI, D'Amato G, et al. Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. Journal of assisted reproduction and genetics. 2017;34(1):149–54.
Yuen W, Golin AP, Flannigan R, Schlegel PN. Histology and sperm retrieval among men with Y chromosome microdeletions. Translational andrology and urology. 2021;10(3):1442–56.
Zhao LM, Jiang H, Hong K, Lin HC, Tang WH, Liu DF, et al. Outcome of treatment of Y chromosome AZFc microdeletion patients. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences. 2016;48(1):607–11.
Alrabeeah K, Wachter A, Phillips S, Cohen B, Al-Hathal N, Zini A. Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia. Andrology. 2015;3(3):462–6.
Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015;104(5):1099–103.e1-3.
Eken A, Gulec F. Microdissection testicular sperm extraction (micro-TESE): Predictive value of preoperative hormonal levels and pathology in non-obstructive azoospermia. The Kaohsiung journal of medical sciences. 2018;34(2):103–8.
Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian journal of andrology. 2018;20(1):30–6.
Ishikawa T. Surgical recovery of sperm in non-obstructive azoospermia. Asian journal of andrology. 2012;14(1):109–15.
Ziaee SA, Ezzatnegad M, Nowroozi M, Jamshidian H, Abdi H, Hosseini Moghaddam SM. Prediction of successful sperm retrieval in patients with nonobstructive azoospermia. Urology journal. 2006;3(2):92–6.
Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int. 2013;111(3):492–9.
Shufaro Y, Prus D, Laufer N, Simon A. Impact of repeated testicular fine needle aspirations (TEFNA) and testicular sperm extraction (TESE) on the microscopic morphology of the testis: an animal model. Human reproduction (Oxford, England). 2002;17(7):1795–9.
Coward RM, Mills JN. A step-by-step guide to office-based sperm retrieval for obstructive azoospermia. Translational andrology and urology. 2017;6(4):730–44.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Effects of age, testicular volume, reproductive hormone, and testicular biopsy on sperm retrieval rate of micro-TESE in NOA patients with AZFc deletion

Status:

Version 1

Abstract

Figures

Introduction

Patients And Methods

Patients

Methods

Procedures

Statistics

Result

Discussion

Conclusion

Abbreviations

Declarations

Acknowledgments

Funding information

Availability of data and materials

Conflict of interest Disclosures

Author’s contribution statement

Consent for publication

Ethics approval and consent to participate

References

Additional Declarations

Status:

Version 1