Predictors for Sperm retrieval by Micro- Dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia

Introduction

Non-obstructive azoospermia (NOA) refers to absence of spermatozoa in the ejaculate due to minimal or impaired spermatogenesis. NOA management usually involves testicular sperm extraction by micro-dissection (Micro-TESE) followed by IVF/ICSI. Nevertheless, there is still lack of predicting parameters for Micro-TESE outcome.

Aim

To evaluate putative predicting factors for retrieval of sperm (and motile sperm) by Micro-TESE in NOA.

Materials & Methods

This retrospective case-control study included 134 Micro-TESEs (131 patients with NOA) performed at Shaare-Zedek medical center. Putative predicting factors for sperm retrieval and motile sperm were derived from patients’ demography and medical history; hormonal and sonographic parameters; semen analysis counts; genetic evaluation and histology of the extracted tissue. Exclusion criteria consists of men with obstructive azoospermia, retrograde ejaculation, and hypothalamic hypogonadism.

Result(s)

Testicular sperm was retrieved in 72 procedures (53.7%). Among them, 53 men (39.6%) had motile sperm at retrieval. Among the various parameters that were analyzed, high serum FSH levels, testicular volume and histology pattern were the most predicting ones.

Conclusion

Sperm retrieval rate was found to be similar to that known in the literature. Level of serum FSH and testicle volume can aid in evaluation prior the surgery, however, their impact is limited. Testicular histology pattern is a reliable predictor, but performance of biopsy prior to TESE is not acceptable.