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

Rohan, Pat; Daly, Niamh; O’Kelly, Aoife; O’Leary, Martin; Dineen, Tim; Shah, Nigam; Daly, Padraig; Waterstone, John; Cullen, Ivor

doi:10.18502/jri.v22i2.5795

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