Download fulltext
HTML
Vahidi, S., Zare Horoki, A., Hashemi Talkhooncheh, M., Jambarsang, S., Dehghan Marvast, L., Sadeghi, A., & Eskandarian, S. (2021). Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: A retrospective study. International Journal of Reproductive BioMedicine (IJRM), 19(9), 781-788. https://doi.org/10.18502/ijrm.v19i9.9710
https://doi.org/10.18502/ijrm.v19i9.9710
statistics
- 515 Abstract Views
- 199 PDF Views
- 0 HTML Views
- Cited by 4 articles
authors
-
Serajoddin Vahidi
Serajoddin Vahidi
Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Ali Zare Horoki
Ali Zare Horoki
Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
-
Mostafa Hashemi Talkhooncheh
Mostafa Hashemi Talkhooncheh
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Sara Jambarsang
Sara Jambarsang
Department of Bio-Statistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Laleh Dehghan Marvast
Laleh Dehghan Marvast
Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Ali Sadeghi
Ali Sadeghi
Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Samane Eskandarian
Samane Eskandarian
Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Published Date
- Oct 10, 2021
Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: A retrospective study
Abstract
Background: The management of non-obstructive azoospermia (NOA) disease relies on microdissection testicular sperm extraction (micro-TESE). Few studies have assessed the role of micro-TESE in men with NOA in our country.
Objective: The aim of the current study was to investigate the success rate of micro- TESE.
Materials and Methods: This retrospective descriptive-analytical study was conducted on 463 men with NOA in Yazd Reproductive Sciences Institute during September 2017 through September 2019. Sperm were retrieved and frozen according to the rapid sperm freezing protocol. After preparing the oocyte of the male partner’s spouse, sperms were thawed and then entered the intracytoplasmic sperm injection process. The clinical pregnancy of individuals was confirmed via ultrasound. Demographic data were extracted from medical records.
Results: The success rate of micro-TESE was 38% and successful fertilization, biochemical pregnancy, clinical pregnancy, and live birth were observed in 111 (85.4%), 29 (22.3%), 29 (22.3%) and 14 (10.7%) men, respectively. A significant difference was seen between the two groups, regarding age (p = 0.01). In addition, the mean follicle-stimulating hormone in men with positive micro-TESE was significantly lower than in men with negative micro-TESE (p = 0.02).
Conclusion: The success of pregnancy in couples with NOA managed via micro-TESE was significant. The study found that the success rate of micro-TESE was higher in older men and in those with lower follicle-stimulating hormone levels.
Key words: Azoospermia, Fertilization, Microdissection, Testicular.
References
[1] Krol M, Nap A, Michels R, Veraart Ch, Goossens L. Health state utilities for infertility and subfertility. Reprod Health 2019; 16(47): 1–8.
[2] Klamia R, Mankonen H, Perheentupaa A. Successful microdissection testicular sperm extraction for men with non-obstructive azoospermia. Repred Biol 2018; 18: 137–142.
[3] Vahidi S, Moein MR, Yazdinejad F, Ghasemi-Esmailabad S, Narimani N. Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center. Int J Reprod Biomed 2020; 18: 1059-1064.
[4] Vahidi S, Ardalan A, Mohammad K. Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pac J Public Health 2009; 21: 287– 293.
[5] Chung E, Brock GB. Cryptorchidism and its impact on male fertility: A state of art review of current literature. Can Urol Assoc J 2011; 5: 210–214.
[6] Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res 2019; 8: 670.
[7] Wosnitzer M, Goldstein M, Hardy MP. Review of azoospermia. Spermatogenesis 2014; 4: e28218. 1– 10.
[8] Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Repord 1995; 10: 1457–1465.
[9] World Health Organization. WHO laboratory manual for the examination and processing of human semen. Switzerland: World Health Organization Press; 2010. 285–286.
[10] Tan YQ, Tu Ch, Meng L, Yuan Sh, Sjaarda C, Luo A, et al. Loss-of-function mutations in TDRD7 lead to a rare novel syndrome combining congenital cataract and nonobstructive azoospermia in humans. Genet Med 2019; 21: 1209–1217.
[11] Arafat M, Har-Vardi I, Harlev A, Levitas E, Zeadna A, Abolfazl-Azab M, et al. Mutation in TDRD9 causes non-obstructive azoospermia in infertile men. J Med Genet 2017; 54: 633–639.
[12] 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: 492–499.
[13] Mangum CL, Patel DP, Jafek AR, Samuel R, Jenkins TG, Aston KI, et al. Towards a better testicular sperm extraction: Novel sperm sorting technologies for non-motile sperm extracted by microdissection TESE. Transl Androl Urol 2020; 9 (Suppl.): S206– S214.
[14] Flannigan R, Bach PhV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol 2017; 6: 745–747.
[15] Franco G, Scarselli F, Casciani V, De Nunzio C, Dente D, Leonardo C, et al. A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urol 2016; 16: 20.
[16] Schlegel PN. Testicular sperm extraction: Microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999; 14: 131–135.
[17] 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 metaanalysis. Fertil Steril 2015; 104: 1099–1103. e3.
[18] Montag MH, Morbeck DE. Principles of IVF laboratory practice: Optimizing performance and outcomes. USA: Cambridge University Press; 2017.
[19] Jawed Sh, Rehman R, Ashfaq Ali M, Abdullah UH, Gul H. Fertilization rate and its determinants in intracytoplasmic sperm injection. Pak J Med Sci 2016; 32: 3–7.
[20] Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009; 24: 2683– 2687.
[21] Tsujimura A. Microdissection testicular sperm extraction: Prediction, outcome, and complications. Int J Urol 2007; 14: 883–889.
[22] Okada H, Dobashi M, Yamazaki T, Hara I, Fujisawa M, Arakawa S, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002; 168: 1063–1067.
[23] Sabbaghian M, Modarresi T, Hosseinifar H, Hosseini J, Farrahi F, Dadkhah F, et al. Comparison of sperm retrieval and intracytoplasmic sperm injection outcome in patients with and without Klinefelter syndrome. Urology 2014; 83: 107–110.
[24] Ramasamy R, Trivedi NN, Reifsnyder JE, Palermo GD, Rosenwaks Z, Schlegel PN. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction. Fertil Steril 2014; 101: 653–655.
[25] Karamazak S, Kizilay F, Bahceci T, Semerci B. Do body mass index, hormone profile and testicular volume effect sperm retrieval rates of microsurgical sperm extraction in the patients with nonobstructive azoospermia? Turk J Urol 2018; 44: 202–207.
[26] Eken A, Gulec F. Microdissection testicular sperm extraction (micro-TESE): Predictive value of preoperative hormonal levels and pathology in non-obstructive azoospermia. Kaohsiung J Med Sci 2018; 34: 103–108.
[27] Davidson LM, Millar K, Jones C, Fatum M, Coward K. Deleterious effects of obesity upon the hormonal and molecular mechanisms controling spermatogenesis and male fertility. Hum Fertil 2015; 18: 184–193.
[28] Salehi P, Derakhshan-Horeh M, Nadeali Z, Hosseinzadeh M, Sadeghi E, Izadpanahi MH, et al. Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients. Clin Exp Reprod Med 2017; 44: 22–27.
[29] Chen Sh-Ch, Hsieh JT, Yu HJ, Chang HCh. Appropriate cut-off value for folliclestimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol 2010; 8: 108–111.
[30] Colpi GM, Colpi EM, Piediferro G, Giacchetta D, Gazzano G, Castiglioni FM, et al. Microsurgical TESE versus conventional TESE for ICSI in nonobstructive azoospermia: A randomized controlled study. Reprod BioMed Online 2009; 18: 315–319.
[31] Ghalayini IF, Al-Ghazo MA, Hani OB, Al-Azab R, Bani-Hani I, Zayed F, et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res 2011; 3: 124–131.
[32] Hawksworth D, Szafran AA, Jordan PW, Dobs AS, Herati AS. Infertility in patients with Klinefelter syndrome: Optimal timing for sperm and testicular tissue cryopreservation. Rev Urol 2018; 20: 56–62.
[33] 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: 492–499.
[34] Amer MK, Ahmed AR, Abdel Hamid AA, GamalEl Din SF. Factors determining the sperm retrieval rate in fresh versus salvage micro-TESE: A comparative cohort study. Int Urol Nephrol 2019; 51: 401–408.
[35] Esteves SC, Miyaoka R, Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011; 37: 570–583.
[36] Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R. Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 2008; 40: 219–226.
[37] Gul T, Turunc T, Haydardedeoglu B, Yaycioglu O, Kuzgunbay B, Ozkardes H. Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: A single centre experience. Andrology 2013; 1: 47–51.
[2] Klamia R, Mankonen H, Perheentupaa A. Successful microdissection testicular sperm extraction for men with non-obstructive azoospermia. Repred Biol 2018; 18: 137–142.
[3] Vahidi S, Moein MR, Yazdinejad F, Ghasemi-Esmailabad S, Narimani N. Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center. Int J Reprod Biomed 2020; 18: 1059-1064.
[4] Vahidi S, Ardalan A, Mohammad K. Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pac J Public Health 2009; 21: 287– 293.
[5] Chung E, Brock GB. Cryptorchidism and its impact on male fertility: A state of art review of current literature. Can Urol Assoc J 2011; 5: 210–214.
[6] Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res 2019; 8: 670.
[7] Wosnitzer M, Goldstein M, Hardy MP. Review of azoospermia. Spermatogenesis 2014; 4: e28218. 1– 10.
[8] Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Repord 1995; 10: 1457–1465.
[9] World Health Organization. WHO laboratory manual for the examination and processing of human semen. Switzerland: World Health Organization Press; 2010. 285–286.
[10] Tan YQ, Tu Ch, Meng L, Yuan Sh, Sjaarda C, Luo A, et al. Loss-of-function mutations in TDRD7 lead to a rare novel syndrome combining congenital cataract and nonobstructive azoospermia in humans. Genet Med 2019; 21: 1209–1217.
[11] Arafat M, Har-Vardi I, Harlev A, Levitas E, Zeadna A, Abolfazl-Azab M, et al. Mutation in TDRD9 causes non-obstructive azoospermia in infertile men. J Med Genet 2017; 54: 633–639.
[12] 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: 492–499.
[13] Mangum CL, Patel DP, Jafek AR, Samuel R, Jenkins TG, Aston KI, et al. Towards a better testicular sperm extraction: Novel sperm sorting technologies for non-motile sperm extracted by microdissection TESE. Transl Androl Urol 2020; 9 (Suppl.): S206– S214.
[14] Flannigan R, Bach PhV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol 2017; 6: 745–747.
[15] Franco G, Scarselli F, Casciani V, De Nunzio C, Dente D, Leonardo C, et al. A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urol 2016; 16: 20.
[16] Schlegel PN. Testicular sperm extraction: Microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999; 14: 131–135.
[17] 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 metaanalysis. Fertil Steril 2015; 104: 1099–1103. e3.
[18] Montag MH, Morbeck DE. Principles of IVF laboratory practice: Optimizing performance and outcomes. USA: Cambridge University Press; 2017.
[19] Jawed Sh, Rehman R, Ashfaq Ali M, Abdullah UH, Gul H. Fertilization rate and its determinants in intracytoplasmic sperm injection. Pak J Med Sci 2016; 32: 3–7.
[20] Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009; 24: 2683– 2687.
[21] Tsujimura A. Microdissection testicular sperm extraction: Prediction, outcome, and complications. Int J Urol 2007; 14: 883–889.
[22] Okada H, Dobashi M, Yamazaki T, Hara I, Fujisawa M, Arakawa S, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002; 168: 1063–1067.
[23] Sabbaghian M, Modarresi T, Hosseinifar H, Hosseini J, Farrahi F, Dadkhah F, et al. Comparison of sperm retrieval and intracytoplasmic sperm injection outcome in patients with and without Klinefelter syndrome. Urology 2014; 83: 107–110.
[24] Ramasamy R, Trivedi NN, Reifsnyder JE, Palermo GD, Rosenwaks Z, Schlegel PN. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction. Fertil Steril 2014; 101: 653–655.
[25] Karamazak S, Kizilay F, Bahceci T, Semerci B. Do body mass index, hormone profile and testicular volume effect sperm retrieval rates of microsurgical sperm extraction in the patients with nonobstructive azoospermia? Turk J Urol 2018; 44: 202–207.
[26] Eken A, Gulec F. Microdissection testicular sperm extraction (micro-TESE): Predictive value of preoperative hormonal levels and pathology in non-obstructive azoospermia. Kaohsiung J Med Sci 2018; 34: 103–108.
[27] Davidson LM, Millar K, Jones C, Fatum M, Coward K. Deleterious effects of obesity upon the hormonal and molecular mechanisms controling spermatogenesis and male fertility. Hum Fertil 2015; 18: 184–193.
[28] Salehi P, Derakhshan-Horeh M, Nadeali Z, Hosseinzadeh M, Sadeghi E, Izadpanahi MH, et al. Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients. Clin Exp Reprod Med 2017; 44: 22–27.
[29] Chen Sh-Ch, Hsieh JT, Yu HJ, Chang HCh. Appropriate cut-off value for folliclestimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol 2010; 8: 108–111.
[30] Colpi GM, Colpi EM, Piediferro G, Giacchetta D, Gazzano G, Castiglioni FM, et al. Microsurgical TESE versus conventional TESE for ICSI in nonobstructive azoospermia: A randomized controlled study. Reprod BioMed Online 2009; 18: 315–319.
[31] Ghalayini IF, Al-Ghazo MA, Hani OB, Al-Azab R, Bani-Hani I, Zayed F, et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res 2011; 3: 124–131.
[32] Hawksworth D, Szafran AA, Jordan PW, Dobs AS, Herati AS. Infertility in patients with Klinefelter syndrome: Optimal timing for sperm and testicular tissue cryopreservation. Rev Urol 2018; 20: 56–62.
[33] 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: 492–499.
[34] Amer MK, Ahmed AR, Abdel Hamid AA, GamalEl Din SF. Factors determining the sperm retrieval rate in fresh versus salvage micro-TESE: A comparative cohort study. Int Urol Nephrol 2019; 51: 401–408.
[35] Esteves SC, Miyaoka R, Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011; 37: 570–583.
[36] Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R. Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 2008; 40: 219–226.
[37] Gul T, Turunc T, Haydardedeoglu B, Yaycioglu O, Kuzgunbay B, Ozkardes H. Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: A single centre experience. Andrology 2013; 1: 47–51.