Sperm retrieval rates and clinical outcomes for patients with different causes of azoospermia who undergo microdissection testicular sperm extraction-intracytoplasmic sperm injection

Hong-Liang Zhang, Lian-Ming Zhao, Jia-Ming Mao, De-Feng Liu, Wen-Hao Tang, Hao-Cheng Lin, Li Zhang, Ying Lian, Kai Hong, Hui Jiang, Hong-Liang Zhang, Lian-Ming Zhao, Jia-Ming Mao, De-Feng Liu, Wen-Hao Tang, Hao-Cheng Lin, Li Zhang, Ying Lian, Kai Hong, Hui Jiang

Abstract

The aim of our study was to compare the sperm retrieval rates (SRRs) and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection (micro-TESE-ICSI). We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing, China, from January 2014 to December 2017. This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI. Patients with azoospermia were classified into Group A (Klinefelter syndrome, n = 284, 125 cycles), Group B (azoospermia Y chromosome factor c [AZFc] microdeletion, n = 91, 64 cycles), Group C (cryptorchidism, n = 52, 39 cycles), Group D (previous mumps and bilateral orchitis, n = 23, 23 cycles), and Group E (idiopathic azoospermia, n = 319, 96 cycles). Clinical characteristics, SRR, embryonic development, and pregnancy outcomes of the patients were compared between all groups. Patients in Group D had the highest and most successful SRR. The average SRR for all patients was 46.0%. The rates of clinical pregnancy, implantation, and live birth in Group D were 78.3%, 65.0%, and 74.0%, respectively, which were higher than those in all other groups (P < 0.05). Group B patients had the lowest clinical pregnancy, implantation, and live birth rates of all groups (P < 0.05). No differences were found in the miscarriage rate or birth defects among the groups (P > 0.05). Patients with orchitis had the highest SRR and best clinical outcomes. Although AZFc microdeletion patients had a higher SRR, their clinical outcomes were worse.

Keywords: azoospermia; intracytoplasmic sperm injection; microdissection testicular sperm extraction; pregnancy outcomes; sperm retrieval rate.

Conflict of interest statement

None

References

    1. Irvine DS. Epidemiology and aetiology of male infertility. Hum Reprod. 1998;13(Suppl 1):33–44.
    1. McLachlan RI, Rajpert-De Meyts E, Hoei-Hansen CE, de Kretser DM, Skakkebaek NE. Histological evaluation of the human testis – approaches to optimizing the clinical value of the assessment: mini review. Hum Reprod. 2007;22:2–16.
    1. Anniballo R, Ubaldi F, Cobellis L, Sorrentino M, Rienzi L, et al. Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rates of sperm retrieval. Hum Reprod. 2000;15:2269–77.
    1. Tavukcuoglu S, Al-Azawi T, Al-Hasani S, Khaki AA, Khaki A, et al. Using fresh and frozen testicular sperm samples in couples undergoing ICSI-MicroTESE treatment. J Reprod Infertil. 2013;14:79–84.
    1. Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, et al. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril. 2009;92:590–3.
    1. Kalsi J, Thum MY, Muneer A, Abdullah H, Minhas S. In the era of micro-dissection sperm retrieval (m-TESE) is an isolated testicular biopsy necessary in the management of men with non-obstructive azoospermia? BJU Int. 2012;109:418–24.
    1. Bocca S, Moussavi V, Brugh V, Morshedi M, Stadtmauer L, et al. ICSI outcomes in men undergoing TESE for azoospermia and impact of maternal age. Andrologia. 2017;49:e12617.
    1. An G, Zou Z, Flannigan R, Liu J, Du H, et al. Outcome of oocyte vitrification combined with microdissection testicular sperm extraction and aspiration for assisted reproduction in men. Med Sci Monit. 2018;24:1379–86.
    1. Al Hasani S, Kupker W, Baschat AA, Sturm R, Bauer O, et al. Mini-swim-up: a new technique of sperm preparation for intracytoplasmic sperm injection. J Assist Reprod Genet. 1995;12:428–33.
    1. Racowsky C, Stern JE, Gibbons WE, Behr B, Pomeroy KO, et al. National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Fertil Steril. 2011;95:1985–9.
    1. Morris JK, Alberman E, Scott C, Jacobs P. Is the prevalence of Klinefelter syndrome increasing? Eur J Hum Genet. 2008;16:163–70.
    1. Gravholt CH, Chang S, Wallentin M, Fedder J, Moore P, et al. Klinefelter syndrome: integrating genetics, neuropsychology, and endocrinology. Endocr Rev. 2018;39:389–423.
    1. Ghalayini IF, Al-Ghazo MA, Hani OB, Al-Azab R, Bani-Hani I, et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res. 2011;3:124–31.
    1. Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl. 2013;23:5.
    1. Zhang S, Li J, Zhou G, Qin S, Xin N, et al. Infertility treatment for azoospermic patients with a history of infectious parotitis (mumps) using combined techniques. Hum Fertil (Camb) 2013;16:266–8.
    1. Ramasamy R, Padilla WO, Osterberg EC, Srivastava A, Reifsnyder JE, et al. A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol. 2013;189:638–42.
    1. Raman JD, Schlegel PN. Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism. J Urol. 2003;170:1287–90.
    1. Oates RD, Silber S, Brown LG, Page DC. Clinical characterization of 42 oligospermic or azoospermic men with microdeletion of the AZFc region of the Y chromosome, and of 18 children conceived via ICSI. Hum Reprod. 2002;17:2813–24.
    1. Sabbaghian M, Mohseni Meybodi A, Rafaee A, Saba S, Zamanian M, et al. Sperm retrieval rate and reproductive outcome of infertile men with azoospermia factor c deletion. Andrologia. 2018;50:e13052.
    1. Zitzmann M, Nordhoff V, von Schonfeld V, Nordsiek-Mengede A, Kliesch S, et al. Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue. Fertil Steril. 2006;86:339–47.
    1. Corona G, Pizzocaro A, Lanfranco F, Garolla A, Pelliccione F, et al. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2017;23:265–75.
    1. Cissen M, Meijerink AM, D'Hauwers KW, Meissner A, van der Weide N, et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod. 2016;31:1934–41.
    1. Liu XY, Wang RX, Fu Y, Luo LL, Guo W, et al. Outcomes of intracytoplasmic sperm injection in oligozoospermic men with Y chromosome AZFb or AZFc microdeletions. Andrologia. 2017;49:1–6.
    1. Haimov-Kochman R, Prus D, Farchat M, Bdolah Y, Hurwitz A. Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques. Int J Androl. 2010;33:e139–43.

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