Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in nonobstructive azoospermia patients

The purpose of this study was to observe the clinical utility and the possible determinants in predicting sperm retrieval of salvage microdissection testicular sperm extraction (mTESE) for nonobstructive azoospermia (NOA) patients with failed conventional TESE at their first attempts. A total of 52 NOA males underwent salvage mTESE were recruited in this study. Related data, including age, BMI, the presence of Klinefelter's syndrome and varicocele, cryptorchidism, mean testicular volume, hormonal profile (total testosterone (TT), follicle‐stimulating hormone (FSH), luteinising hormone (LH), inhibin B (INHB)), testicular histology and surgical duration, were collected and analysed. A multivariate logistic regression with likelihood ratio test revealed the following predictors of sperm retrieval: TT and testicular histology (chi‐square of likelihood ratio = 26.42, df = 4, p < .005). A formula was also established using multivariate regression analysis in predicting sperm retrieval probability. A predicted probability of more than 71% was determined of the formula as the cut‐off value in predicting sperm retrieval using receiver operating characteristics (ROC) analysis with a sensitivity and specificity 78.0% and 72.4% respectively. In conclusion, salvage mTESE is of clinical value in NOA males with failed TESE attempts, whereas the established formula could be useful in determining the proper salvage mTESE candidates.     

Paternal age as an independent factor does not affect embryo quality and pregnancy outcomes of testicular sperm extraction‐intracytoplasmic sperm injection in azoospermia

This study was performed to evaluate the independent influence of paternal age affecting embryo development and pregnancy using testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI) in obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). Paternal patients were divided into the following groups: ≤30 years, 31–35 years, 36–40 years, 41–45 years and ≥46 years. There were no differences in the rates of fertilisation or embryo quality according to paternal and maternal age. However, clinical pregnancy and implantation rates were significantly lower between those ≥46 years of paternal age compared with other age groups. Fertilisation rate was higher in the OA than the NOA, while embryo quality, pregnancy and delivery results were similar. Clinical pregnancy and implantation rates were significantly lower for patients ≥46 years of paternal age compared with younger age groups. In conclusion, fertilisation using TESE in azoospermia was not affected by the independent influence of paternal age; however, as maternal age increased concomitantly with paternal age, rates of pregnancy and delivery differed between those with paternal age <41 years and ≥46 years. Therefore, paternal age ≥46 years old should be considered when applying TESE‐ICSI in cases of azoospermia, and patients should be advised of the associated low pregnancy rates.     

Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia

Aim： To evaluate the outcome of repetitive micro-surgical testicular sperm extraction （mTESE） attempts in non-obstructive azoospermia （NOA） cases, in relation to patients＇ initial testicular histology results. Methods： A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection （ICSI） attempts were reviewed. Results： Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 （64%） （Sp^＋）, and failed in the remaining 24 （36%） （Sp^-）. Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp^＋ but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two （n = 24）, three （n = 4） and four （n = 1） times. The second attempt yielded mature sperm in 3/5 patients from the Sp group and 16/19 patients from the Sp^＋ group. At the third and fourth trials, 4/4 and 1/1 of the original Sp^＋ patients were Sp^＋ again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome （16%）, maturation arrest （22%）, hypospermatogenesis （21%） and focal spermatogenesis （41%）. Overall, in repetitive mTESE, 24/29 （82%） of the attempts were finally Sp^＋. Conclusion： Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.     

High prevalence of urogenital infection/inflammation in patients with azoospermia does not impede surgical sperm retrieval

Considering infection/inflammation to be an important risk factor in male infertility, the aim of this study was to make a comprehensive evaluation of the prevalence of urogenital tract infection/inflammation and its potential impact on sperm retrieval in azoospermic patients. In this prospective study, 71 patients with azoospermia were subjected to an extensive andrological workup including comprehensive microbiological diagnostics (2‐glass test, semen, testicular swab and testicular tissue analysis) and testicular biopsy/testicular sperm extraction (TESE). Medical history suggested urogenital tract infection/inflammation in 7% of patients, 11% harboured STIs, 14% showed significant bacteriospermia, 15% had seminal inflammation, 17% fulfilled the MAGI definition, and 27% had relevant pathogens. At the testicular level, 1 patient had a swab positive for bacteria, no viruses were detected, tissue specimens never indicated pathogens, whereas histopathology revealed focal immune cell infiltrates in 23% of samples. Testicular sperm retrieval rate was 100% in obstructive and 46% in nonobstructive azoospermia. None of the infection/inflammation‐related variables was associated with the success of sperm retrieval or inflammatory lesions in the testis. The high prevalence of urogenital infection/inflammation among azoospermic men underpins their role as significant aetiologic factors in male infertility. However, this observation does not refer to the chances of sperm retrieval at the time of surgery/TESE.     

非梗阻性无精子症患者睾丸活检组织细胞悬液检查与病理组织学检查精子检出率的差异性研究

目的:比较非梗阻性无精子症(NOA)患者睾丸活检组织细胞悬液检查与病理组织学检查精子检出率的差异,探讨两种检查方法结果不一致时获取精子的可靠性及临床治疗方案的选择。方法:1 112例NOA患者接受睾丸精子抽吸术(testicular sperm extraction,TESE),睾丸活检组织分别进行细胞悬液检查和病理组织学检查。结果:两种检查方法结果一致率为92.63%,一致精子检出率为41.82%,一致精子未检出率为50.81%。Kappa分析表明两种检查方法的一致性强度属于最强。25例进入辅助生殖周期的细胞悬液检查发现精子而组织学检查未发现精子患者中,24例患者取卵日成功获取精子(取精成功率为96.0%)并实施卵胞质内单精子注射(ICSI),其治疗结局为8例临床妊娠(33.33%)、4例流产(16.67%)、12例未妊娠(50.0%)。结论:实施诊断性TESE时,采用睾丸活检组织的细胞悬液检查与组织病理学检查双重评估精子检出率的方法,结果一致率高并且迅捷、准确、可靠,为NOA患者进入辅助生殖周期时成功取到精子提供了保障。当两种检查方法结果不一致时,细胞悬液检查对临床治疗方案的选择指导意义更大。     

冻融复苏微量精子行卵细胞胞质内单精子注射术的疗效及临床妊娠结局分析

目的:回顾性分析123例无精子症患者经皮附睾精子抽吸术(PESA)或经皮睾丸精子抽吸术(TESA)后冻融复苏微量精子行卵细胞胞质内单精子注射术(ICSI)的疗效及临床妊娠结局情况。方法:将采用微量冻融PESA、TESA精子行ICSI的病例归为冻融精子组,采用新鲜PESA、TESA精子行ICSI的病例归为对照组。比较冻融精子组与新鲜精子组组间及组内的双原核(2PN)受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率、多胎妊娠率有无统计学差异。结果:PESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为75.67%vs76.49%,64.96%vs66.19%,55.21%vs57.22%,13.21%vs12.61%,3.77%vs5.41%,37.74%vs37.84%(P>0.05),TESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为74.41%vs76.43%,64.63%vs66.35%,46.81%vs53.39%,18.18%vs14.55%,4.55%vs1.82%,37.74%vs37.84%,组间及组内均无统计学差异(P>0.05)。PESA精子与TESA精子冻融复苏成功率为70.07%vs62.67%,无统计学差异(P>0.05)。结论:微量PESA及TESA精子冻融技术对无精子症患者来说是一种安全、经济、有效的治疗方法;精子冷冻复苏技术有待于进一步提高;该技术是否会增加子代远期遗传风险仍有待于进一步探讨和研究。     

Sperm source does not affect the ICSI outcome of patients with severely compromised spermatogenesis

Patients with spermatogenic dysfunction may display sperm parameters ranging from extremely severe oligozoospermia (sperm count lower than 2 million/ml) to azoospermia. It has been proposed that, since these patients may have increased sperm DNA damage that could affect their ICSI outcome, the use of surgically retrieved testicular spermatozoa should be preferred to improve their chance of fathering their biological offspring. However, studies in this field have yielded conflicting results. The present study provides an updated assessment of this subject by comparing the ICSI outcome of 762 patients with nonobstructive azoospermia and 419 with sperm count lower than 2 million/ml (median sperm count 300,000/ml). Both groups were homogeneous for the number of retrieved and injected MII oocytes. No difference was seen in terms of fertilisation, clinical pregnancy and cumulative live birth rates. Only the number of injected MII oocytes was found to independently predict the live birth rate, even when adjusted for the number of transferred embryos (OR 1.10 (1.0–1.2, p = 0.038)). The results of the present study stand against the use of testicular spermatozoa in patients with extremely severe spermatogenic dysfunction with available spermatozoa in their ejaculate.     

非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精结果的相关性研究

目的:探讨非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精术(TESA)结果的相关性,以及可用于预测TESA结果的睾丸体积、生殖激素水平的切点值,从而为非梗阻性无精子症患者进一步诊疗提供重要资料。方法:121例研究对象均为非梗阻性无精子症患者(NOA),测定其睾丸体积和生殖激素水平,并根据TESA结果分为无精子组和有精子组。结果:无精子组和有精子组的左侧睾丸体积(ml)、右侧睾丸体积(ml)、泌乳素(PRL,ng/ml)、卵泡刺激素(FSH,mIU/ml)、黄体生成素(LH,mIU/ml)、雌二醇(E2,pmol/L)、血清总睾酮(TT,nmol/L)水平分别为7.07±1.06和11.75±1.38、7.37±1.37和11.70±1.98、12.43±11.69和9.60±4.55、15.77±10.84和8.01±7.43、6.12±2.92和8.11±20.11、119.36±43.52和141.12±48.33、11.43±4.05和12.46±4.60。无精子组血清FSH和PRL水平平均值高于有精子组,并且有显著的统计学差异。虽然无精子组的睾丸体积平均数小于有精子组,但两组之间没有统计学差异。对于年龄、血清E2和TT水平,两组之间也没有统计学差异。利用ROC曲线优选的睾丸体积切点值为9 ml,此点其敏感性为93.8%/89.6%(左/右),特异性为100%/94.3%(左/右),睾丸体积ROC曲线的AUC为0.984/0.961(左/右),表明其诊断准确性较高;优选的血清FSH水平切点值为8.18 mIU/ml,此点其敏感性为71.2%,特异性为75.0%,FSH水平ROC曲线的AUC为0.743,表明其诊断准确性中等。结论:睾丸体积和FSH水平对于预测NOA患者TESA结果具有重要意义,并且睾丸体积诊断准确性明显优于FSH。