Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia

Authors
Pat Rohan 1
Niamh Daly 2
Aoife O’Kelly 1
Martin O’Leary 3
Tim Dineen 2
Nigam Shah 4
Padraig Daly 1
John Waterstone 2
Ivor Cullen 1
1 Department of Urology, University Hospital Waterford, Waterford, Ireland
2 Waterstone Clinic, Cork, Ireland
3 College of Science, University College Dublin, Dublin, Ireland
4 Department of Pathology, University Hospital Waterford, Waterford, Ireland
10.18502/jri.v22i2.5795
Abstract
Background: Microdissection testicular sperm extraction (mTESE) is the gold standard approach in sperm retrieval in men with non-obstructive azoospermia (NOA). The purpose of the study was to assess the outcomes for Irish men who have undergone mTESE with a single surgeon. Methods: This is a retrospective, single cohort study. Thirty-four patients underwent mTESE between September 2015 and June 2019. A p<0.05 was considered statistically significant. Results: In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10-5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle. Conclusion: The combination of mTESE/Intracytoplasmic sperm injection (ICSI) is the best option available for men with NOA who prefer to achieve paternity using their own DNA. Given the overall SRRs in mTESE, it is imperative to continue research for a predictive model to better counsel azoospermic men regarding the use of mTESE. For this purpose, large, multicenter, randomized controlled trials are needed.
Keywords
Male infertility
Microdissection testicular sperm extraction
Non
obstructive azoospermia
Predictive markers
Sperm retrieval
  1. Dabaja AA, Schlegel PN. Microdissection testicular sperm extraction: an update. Asian J Androl. 2013;15(1):35-9.
  2. 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 meta-analysis. Fertil Steril. 2015;104(5):1099-103.e1-3.
  3. 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(3):492-9.
  4. Aziz N, Agarwal A. The diagnosis and treatment of male infertility: a case-based guide for clinicians. 1st ed. USA: Springer; 2017. 318 p.
  5. Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? a systematic review. Hum Reprod Update. 2007;13(6):539-49.
  6. Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo). 2011;66(4):691-700.
  7. Johnson L. Evaluation of the human testis and its age-related dysfunction. Prog Clin Biol Res. 1989;302:35-60.
  8. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. 1999;14(1):131-5.
  9. Griswold MD. The central role of sertoli cells in spermatogenesis. Semin Cell Dev Biol. 1998;9(4):411-6.
  10. Johnsen SG. Testicular biopsy score count--a method for registration of spermatogenesis in human testes: normal values and results in 335 hypogonadal males. Hormes. 1970;1(1):2-25.
  11. Devroey P, Liu J, Nagy Z, Tournaye H, Silber SJ, Van Steirteghem AC. Normal fertilization of human oocytes after testicular sperm extraction and intracytoplasmic sperm injection. Fertil Steril. 1994;62(3):639-41.
  12. Flannigan R, Bach PV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol. 2017;6(4):745-52.
  13. Waterstone Clinic. First Pregnancy following Micro-TESE in Ireland [Internet]. Waterstone Clinic: Ireland; 1 Jun 2016. Available from: https://waterstoneclinic.ie/first-micro-tese-pregnancy-ireland/.
  14. Tsujimura A, Matsumiya K, Miyagawa Y, Takao T, Fujita K, Koga M, et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol. 2004;172(5 Pt 1):1944-7.
  15. Tsujimura A. Microdissection testicular sperm extraction: Prediction, outcome, and complications. Int J Urol. 2007;14(10):883-9.
  16. Schlegel PN, Tanrikut C, Li PS. Microdissection testicular sperm extraction (TESE) in non-obstructive azoospermia. Fertil Steril. 2006;86(3):S519.
  17. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70(3):532-8.
  18. Dadhich P, Ramasamy R, Scovell J, Wilken N, Lipshultz L. Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men. Indian J Urol. 2017;33(3):236-40.
  19. Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int. 2012;110(4):573-8.
  20. Ishikawa T. Surgical recovery of sperm in non-obstructive azoospermia. Asian J Androl. 2012;14(1):109-15.
  21. Crabbe E, Verheyen G, Silber S, Tournaye H, Van de Velde A, Goossens A, et al. Enzymatic digestion of testicular tissue may rescue the intracytoplasmic sperm injection cycle in some patients with non-obstructive azoospermia. Hum Reprod. 1998;13(10):2791-6.
  22. Tournaye H, Verheyen G, Nagy P, Ubaldi F, Goossens A, Silber S, et al. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod. 1997;12(1):80-6.
  23. 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(2):103-8.
  24. Cetinkaya M, Onem K, Zorba OU, Ozkara H, Alici B. Evaluation of microdissection testicular sperm extraction results in patients with non-obstructive azoospermia: independent predictive factors and best cutoff values for sperm retrieval. Urol J. 2015;12(6):2436-43.
  25. Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014;2(1):20-4.
  26. Ziaee SA, Ezzatnegad M, Nowroozi M, Jamshidian H, Abdi H, Moghaddam SMMH. Prediction of successful sperm retrieval in patients with nonobstructive azoospermia. Urol J. 2006;3(2):92-6.
  27. Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, Schlegel PN. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril. 2009;92(2):590-3.
  28. Ramasamy R, Yagan N, Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology. 2005;65(6):1190-4.
  29. Tunc L, Kirac M, Gurocak S, Yucel A, Kupeli B, Alkibay T, et al. Can serum Inhibin B and FSH levels, testicular histology and volume predict the outcome of testicular sperm extraction in patients with non-obstructive azoospermia? Int Urol Nephrol. 2006;38(3-4):629-35.
  30. Jensen CFS, Ohl DA, Hiner MR, Fode M, Shah T, Smith GD, et al. Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men. Andrology. 2016;4(2):257-62.
  31. Vernaeve V, Tournaye H, Schiettecatte J, Verheyen G, Steirteghem AV, Devroey P. Serum inhibin B cannot predict testicular sperm retrieval in patients with non-obstructive azoospermia. Hum Reprod. 2002;17(4):971-6.
  32. Meachem SJ, Nieschlag E, Simoni M. Inhibin B in male reproduction: pathophysiology and clinical relevance. Eur J Endocrinol. 2001;145(5):561-71.
  33. Katz MJ, Huland DM, Ramasamy R. Multiphoton microscopy: applications in Urology and Andrology. Transl Androl Urol. 2014;3(1):77–83.
  34. Ramasamy R, Sterling J, Fisher ES, Li PS, Jain M, Robinson BD, et al. Identification of Spermatogenesis With Multiphoton Microscopy: An Evaluation in a Rodent Model. J Urol. 2011;86(6):2487-92.
  35. Najari BB, Ramasamy R, Sterling J, Aggarwal A, Sheth S, Li PS, et al. Pilot study of the correlation of multiphoton tomography of ex vivo human testis with histology. J Urol. 2012;188(2):538-43.
Journal of Reproduction & Infertility
Volume 22, Issue 2
Spring 2021
Pages 103-109