Evaluation of the Results of Intracytoplasmic Sperm Injection and Microdissection Testicular Sperm Extraction Treatments in Patients with Nonobstructive Azoospermia According to Etiological Factors: A Retrospective Analysis

Yusuf Arıkan; Enes Dumanli; Abdurrahman Hamdi İnan; Mehmet Zeynel Keskin

doi:10.58600/eurjther2193

Authors

Yusuf Arıkan Department of Urology, Izmir Tepecik Training and Research Hospital, İzmir, Türkiye https://orcid.org/0000-0003-0823-7400
Enes Dumanli Department of Urology, Izmir Tepecik Training and Research Hospital, İzmir, Türkiye https://orcid.org/0009-0001-5305-477X
Abdurrahman Hamdi İnan Department of Gynecology, Izmir Tepecik Training and Research Hospital, İzmir, Türkiye https://orcid.org/0000-0003-4782-3955
Mehmet Zeynel Keskin Department of Urology, Izmir Tepecik Training and Research Hospital, İzmir, Türkiye https://orcid.org/0000-0002-9206-5586

DOI:

https://doi.org/10.58600/eurjther2193

Keywords:

Nonobstructive Azoospermia, microTESE, Intracytoplasmic Sperm Injection, Male Infertility

Abstract

Objective: This study aimed to retrospectively compare the results of microdissection testicular sperm extraction (microTESE) and Intracytoplasmic sperm injection (ICSI) treatments in nonobstructive azoospermia (NOA) patients with different aetiologies. Determinants (clinical characteristics) for microTESE outcomes were compared between patients with successful sperm retrieval (SSR) and sperm retrieval failure (SRF).

Methods: A total of 510 NOA patients who underwent microTESE between January 2015 and January 2024 were included in this study. Patients were classified according to the cause of NOA and SSR, fertilisation rate, clinical pregnancy, and overall live birth rate were evaluated.

Results: The SSR rate was 44.1% in the whole population. The idiopathic patient group had the lowest SSR rate (X²: 34.81; p<0.01). There was no difference between the groups in terms of fertilisation rate, clinical pregnancy and overall live birth rate. There was a negative correlation between age and SSR rates in patients with idiopathic NOA (t:-0.27; p<0.01). SSR rates were higher in patients with cryptorchidism (right: t:0.8; P:0.003; left: t:0.72; p:0.002) and mumps orchitis (right: t:0.76; P<0.01; left: t:0.76; p=0.003).

Conclusion: Etiology has a significant role in terms of SSR in patients with NOA. SSR was found to be significantly less in patients with idiopathic NOA compared to other causes. In addition, age and testicular volume were significant predictive factors for SSR in patients with idiopathic and acquired NOA.

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References

Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, Arafa M, Panner Selvam MK, Shah R (2021) Male infertility. Lancet. Jan 23;397(10271):319-333. doi: 10.1016/S0140-6736(20)32667-2. Epub 2020 Dec 10. PMID: 33308486.

Sharma M, Leslie SW (2023) Azoospermia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 18, 2023.

Jiang H, Zhang Y, Ma H, Fan S, Zhang H, Shi Q (2022) Identification of pathogenic mutations from nonobstructive azoospermia patients. Biol Reprod. 107: 85-94. doi: 10.1093/biolre/ioac089. PMID: 35532179.

Chen X, Ma Y, Zou S, Wang S, Qiu J, Xiao Q, Zhou L, Ping P (2019) Comparison and outcomes of nonobstructive azoospermia patients with different etiology undergoing MicroTESE and ICSI treatments. Transl Androl Urol. 8: 366-73. doi:10.21037/tau.2019.04.08. PMID: 31555560; PMCID: PMC6732089.

Tharakan T, Luo R, Jayasena CN, Minhas S (2021) Non-obstructive azoospermia: current and future perspectives. Fac Rev. Jan 26;10:7. doi: 10.12703/r/10-7. PMID: 33659925; PMCID: PMC7894261.

Wang K, Tang D, Zhu Q, Yang D, Yang H, Peng J, Ding D, Wang J, Wang Q, Cao Y, Chen B, Zhang Z (2023) Micro-TESE surgery combined with ICSI regimen in the treatment of non-obstructive azoospermia patients and its effect analysis. Zygote. Feb;31(1):55-61. doi: 10.1017/S096719942200051X. Epub 2022 Oct 21. PMID: 36268556.

Mao J, Deng C, Zhao L, Liu D, Lin H, Zhang Z, Yang Y, Zhang H, Li R, Hong K, Jiang H (2023) Micro-TESE strategy in patients with NOA caused by AZFc deletion: synchronous or asynchronous? Zygote. Feb;31(1):25-30. doi: 10.1017/S0967199422000466. Epub 2022 Oct 7. PMID: 36205231.

Sharma A, Minhas S, Dhillo WS, Jayasena CN (2021) Male infertility due to testicular disorders. J Clin Endocrinol Metab. Jan 23;106(2):e442-e459. doi: 10.1210/clinem/dgaa781. PMID: 33295608; PMCID: PMC7823320.

Esteves SC (2015) Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl. May-Jun;17(3):459-70. doi: 10.4103/1008-682X.148719. PMID: 25677138; PMCID: PMC4430952.

Topuz B, Ebiloğu T, Sarıkaya S, Kaya E, Fidan U, Korkmaz C, Ceyhan ST, Bedir S, Gürdal M, Karataş ÖF (2021) The timing of micro-TESE: what is the ideal age for male and female partner to bring a child to home? Rev Assoc Med Bras (1992). Jul;67(7):958-965. doi: 10.1590/1806-9282.20210290. PMID: 34817506.

Pook CJ, Cocca A, Grandone A, Al-Hussini M, Lam W (2021) The Evidence for Fertility Preservation in Pediatric Klinefelter Syndrome. Front Reprod Health. Aug 3;3:629179. doi: 10.3389/frph.2021.629179. PMID: 36304035; PMCID: PMC9580826.

Bryson CF, Ramasamy R, Sheehan M, Palermo GD, Rosenwaks Z, Schlegel PN (2014) Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction. J Urol. Jan;191(1):175-8. doi: 10.1016/j.juro.2013.07.065. Epub 2013 Aug 1. PMID: 23911635; PMCID: PMC4077600.

Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, Fusco F, Kadioglou A, Kliesch S, Kopa Z, Krausz C, Pelliccione F, Pizzocaro A, Rassweiler J, Verze P, Vignozzi L, Weidner W, Maggi M, Sofikitis N (2019) Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. Nov 5;25(6):733-757. doi: 10.1093/humupd/dmz028. PMID: 31665451.

Achermann APP, Pereira TA, Esteves SC (2021) Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. Int Urol Nephrol. Nov;53(11):2193-2210. doi: 10.1007/s11255-021-02979-4. Epub 2021 Aug 19. PMID: 34410586.

Zhang HL, Zhao LM, Mao JM, Liu DF, Tang WH, Lin HC, Zhang L, Lian Y, Hong K, Jiang H (2021) Sperm retrieval rates and clinical outcomes for patients with different causes of azoospermia who undergo microdissection testicular sperm extraction-intracytoplasmic sperm injection. Asian J Androl. Jan-Feb;23(1):59-63. doi: 10.4103/aja.aja_12_20. PMID: 32341210; PMCID: PMC7831829.

The Trinh S, Nguyen NN, Thi Thu Le H, Thi My Pham H, Tien Trieu S, Tran NTM, Sy Ho H, Van Tran D, Van Trinh T, Trong Hoang Nguyen H, Pham Minh N, Duc Dang T, Huu Dinh V, Thi Doan H (2023) Screening Y Chromosome Microdeletion in 1121 Men with Low Sperm Concentration and the Outcomes of Microdissection Testicular Sperm Extraction (mTESE) for Sperm Retrieval from Azoospermic Patients. Appl Clin Genet. Aug 28;16:155-164. doi: 10.2147/TACG.S420030. PMID: 37663123; PMCID: PMC10473397.

Küçükaslan AŞ, Çetintaş VB, Altıntaş R, Vardarlı AT, Mutlu Z, Ulukuş M, Semerci B, Eroğlu Z (2013) Identification of Y chromosome microdeletions in infertile Turkish men. Turk J Urol. Sep;39(3):170-4. doi: 10.5152/tud.2013.035. PMID: 26328103; PMCID: PMC4548623.