Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients

  • Salehi, Peyman (Shahid Beheshti Infertility Center, Isfahan University of Medical Sciences) ;
  • Derakhshan-Horeh, Marzieh (Department of Anatomy, School of Medicine, Tehran University of Medical Sciences) ;
  • Nadeali, Zakiye (Medical Genetics Laboratory, Al-Zahra University Hospital) ;
  • Hosseinzadeh, Majid (Medical Genetics Laboratory, Al-Zahra University Hospital) ;
  • Sadeghi, Erfan (Department of Biostatistics and Epidemiology, School of Public Health, Kermanshah University of Medical Sciences) ;
  • Izadpanahi, Mohammad Hossein (Department of Urology, Isfahan University of Medical Sciences) ;
  • Salehi, Mansour (Medical Genetics Laboratory, Al-Zahra University Hospital)
  • Received : 2016.11.14
  • Accepted : 2017.02.02
  • Published : 2017.03.31
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Abstract

Objective: Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval. Methods: We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome. Results: The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (p<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; p<0.01). A logistic regression model demonstrated that high levels of follicle-stimulating hormone (FSH) and small testicular volume were significantly associated with lower chances of successful sperm retrieval. Conclusion: Some parameters, including testicular histopathology patterns, FSH levels, testicular volume, and method of TESE surgery, may be able to predict the chances of obtaining spermatozoa in patients with NOA. However, despite the efficiency of some predictive models, the hope of retrieving any functioning spermatozoa may be sufficient to disregard predictive factors of the success of intracytoplasmic sperm injection in these patients.

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References

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