Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia |
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Authors: | Friedler S; Raziel A; Strassburger D; Soffer Y; Komarovsky D; Ron-El R |
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Institution: | Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. |
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Abstract: | The efficiency of testicular sperm retrieval by testicular fine needle
aspiration (TEFNA) was compared with open biopsy and testicular sperm
extraction (TESE), in 37 rigorously selected patients with non- obstructive
azoospermia. All patients underwent TEFNA and TESE consecutively. Thus,
each patient served as his own control. The case was regarded as successful
if at least one testicular spermatozoon was found allowing intracytoplasmic
sperm injection (ICSI) of at least one oocyte. The mean age of the male
patients was 32.7 years (range 24-47). Whereas by TEFNA spermatozoa
enabling performance of ICSI were found in only four patients out of 37
(11%), open biopsy and TESE yielded spermatozoa in 16 cases (43%). The
negative predictive value of high serum follicle stimulating hormone (FSH)
concentrations (> or =10 IU/l) (predicting failure to find spermatozoa
for ICSI) was low (38.4%). The positive predictive value (predicting the
chance to find spermatozoa for ICSI) of normal-sized testicle was not
different from that of small- sized (<15 ml) testicle (50%).
Complications included one case of testicular bleeding following fine
needle aspiration, treated locally, and two cases of extratunical
haematomata following TESE requiring no intervention. In patients with
non-obstructive azoospermia, TEFNA has a significantly lower yield compared
to TESE. Performance of ICSI with testicular sperm in these cases resulted
in satisfactory fertilization and high embryo transfer rates. The
implantation and pregnancy rates per embryo transfer were 13 and 29%
respectively. Neither serum FSH values nor testicular size were predictive
of the chances to find spermatozoa for ICSI. Some complications may occur
even following TEFNA.
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