Non-Obstrüktif Azospermide Tek Taraflı Mikroskopik Testiküler Sperm Ekstraksiyonu

Abstract

Amaç: Çalışmamızda, kliniğimizdeki non-obstrüktif azoospermi (NOA) olgularında tek taraflı mikroskobik testiküler sperm ekstraksiyonu (mTESE) sonuçlarımızı sunmayı ve başarıyı etkileyen faktörleri ortaya koymayı amaçladık.

Gereç ve Yöntemler: Çalışmamıza toplam 102 NOA hastası dahil edildi. Hastaların testis hacimleri, serum folikül uyarıcı hormon (FSH), lüteinizan hormon (LH), prolaktin (PRL) ve testosteron (T) düzeyleri ölçüldü, genetik değerlendirmeleri yapıldı. Ardından mTESE uygulanarak hastalar, sperm ekstraksiyonunun başarılı (sperm bulunan) veya başarısız (sperm bulunmayan) olmasına göre iki gruba ayrıldı. Gruplar demografik, klinik ve histopatolojik veriler açısından karşılaştırıldı.

Bulgular: mTESE ile sperm ekstraksiyonu başarı oranımız %62.7 idi (n=64). İki grup arasında yaş, infertilite süresi, serum T ve PRL düzeyleri açısından anlamlı fark yoktu (sırasıyla p=0.896, p=0.357, p=0.504, p=0.179). mTESE'nin başarılı olduğu grupta ortalama testis hacmi anlamlı olarak daha yüksek olup, serum FSH ve LH düzeyleri anlamlı olarak düşüktü (sırasıyla p=0.029, p=0.004, p=0.001). Histopatolojik değerlendirmede mTESE başarısı açısından hipospermatogenez, sertoli cell only sendromu (SCOS) ve matürasyon arrest (MA) grupları arasında anlamlı fark bulundu (sırasıyla % 88.5, %37.5, % 30; p<0.001).

Sonuç: Tek taraflı mTESE başarı oranımız, daha önce bildirilen bilateral serilerle benzer olarak bulundu. mTESE başarısını etkileyen birden çok prediktif faktör bulunmakla birlikte, tek taraflı mTESE uygulamasının daha az invaziv olması ve kontralateral testis bütünlüğünün korunması nedeniyle kurtarma mTESE açısından avantaj sağlayabilir. 

Keywords

• Non-obstrüktif azoospermia,Mikro-TESE,Sperm elde etme,Unilateral

Unilateral Microscopic Testicular Sperm Extraction in Non-Obstructive Azoospermia

Abstract

Purpose: We aimed to present the results of unilateral microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermia (NOA) cases in our clinic and to elucidate the factors affecting mTESE success. 

Materials and Methods: Our study was prospectively designed and 102 NOA patients were included. Testis volumes, serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone (T) levels were measured and genetic evaluations were carried out. We performed mTESE and divided patients into two groups according to sperm extraction results as mTESE is successful (sperm could be found) or failed (sperm could not be found). The two groups were compared in demographic, clinical and histopathological data.

Results: Sperm extraction by mTESE was successful in 64 (62.7%) patients. There was no significant difference between two groups in terms of age, infertility times, serum T and PRL levels (p=0.896, p=0.357, p=0.504, p=0.179, respectively). Serum FSH and LH levels were significantly lower, and the mean testis volume was significantly higher in the group that micro-TESE was successful (p=0.004, p=0.001, p=0.029, respectively). Histopathological evaluation revealed a significant difference between hypospermatogenesis, sertoli cell only syndrome (SCOS) and maturation arrest (MA) groups in terms of mTESE success (88.5%, 37.5%, 30%, respectively; p<0.001).

Conclusion: Our unilateral mTESE success rate was similar to those performed bilaterally in literature. Besides the multiple predictive factors of mTESE success rate, unilaterally performed mTESE is less invasive procedure preserving the integrity of the contralateral testis and may be advantageous in terms of improving salvage mTESE results. 

Keywords

• Non-obstructive azoospermia,Micro-TESE,Sperm retrieval,Unilateral

References

1. 1. Goktolga U, Izetbegovic S, Rama A, Spahovic H, Goktas C. The First Report from Bosnia and Herzegovina on Micro-tese Results in Azoospermic Patients. Med Arch 2015; 69: 196 - 9.
2. 2. Abdel Raheem A, Garaffa G, Rushwan N, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int 2013; 111: 492 - 9.
3. 3. Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl 2013; 23: 5.
4. 4. 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.
5. 5. Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989; 142: 62 - 5.
6. 6. Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo) 2011; 66: 691 - 700.
7. 7. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999; 14: 131 - 5.
8. 8. Zitzmann M, Nordhoff V, von Schonfeld V, 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.

9. 9. Ramasamy R, Lin K, Gosden LV, 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.
10. 10. Aydos K, Unlu C, Demirel LC, Evirgen O, Tolunay O. The effect of pure FSH administration in non-obstructive azoospermic men on testicular sperm retrieval. Eur J Obstet Gynecol Reprod Biol 2003; 108: 54 - 8.
11. 11. Tsujimura A. Microdissection testicular sperm extraction: prediction, outcome, and complications. Int J Urol 2007; 14: 883-9.
12. 12. Shinjo E, Shiraishi K, Matsuyama H. The effect of human chorionic gonadotropin-based hormonal therapy on intratesticular testosterone levels and spermatogonial DNA synthesis in men with non-obstructive azoospermia. Andrology 2013; 1: 929 - 35.
13. 13. Kato Y, Shiraishi K, Matsuyama H. Expression of testicular androgen receptor in non-obstructive azoospermia and its change after hormonal therapy. Andrology 2014; 2: 734 - 40.
14. 14. Eliveld J, van Wely M, Meißner A, et al. The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Human reproduction update, 2018; 24: 442 - 454.
15. 15. Okada H, Dobashi M, Yamazaki T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002; 168: 1063 - 7.
16. 16. Ozturk U, Ozdemir E, Dede O, et al. Assessment of anti-sperm antibodies in couples after testicular sperm extraction. Clin Investig Med 2011; 34: 179 - 184.
17. 17. Hussein A, Ozgok Y, Ross L, Rao P, Niederberger C. Optimization of spermatogenesis-regulating hormones in patients with non-obstructive azoospermia and its impact on sperm retrieval: a multicentre study. BJU Int 2013; 111: E110 - 4.
18. 18. Shiraishi K, Ohmi C, Shimabukuro T, Matsuyama H. Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia. Hum Reprod 2012; 27: 331 - 9.
19. 19. Reifsnyder JE, Ramasamy R, Husseini J, Schlegel PN. Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 2012; 188: 532 - 6.
20. 20. Bryson CF, Ramasamy R, Sheehan M, et al. Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction. J Urol 2014; 191: 175 - 8.
21. 21. 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.
22. 22. Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 1998; 70: 71 - 5.
23. 23. Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril 2004; 81: 1585 - 8.
24. 24. Jezek D, Knuth UA, Schulze W. Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men. Hum Reprod 1998; 13: 1230 - 4.
25. 25. Sousa M, Cremades N, Silva J, et al. Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids. Hum Reprod 2002; 17: 1800 - 10.
26. 26. Su LM, Palermo GD, Goldstein M, et al. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia: testicular histology can predict success of sperm retrieval. J Urol 1999; 161: 112 - 6.
27. 27. Tournaye H, Verheyen G, Nagy P, et al. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod 1997; 12: 80 - 6.
28. 28. Schoor RA, Elhanbly S, Niederberger CS, Ross LS. The role of testicular biopsy in the modern management of male infertility. J Urol 2002; 167: 197-200.
29. 29. Kalsi JS, Shah P, Thum Y, et al. Salvage micro-dissection testicular sperm extraction; outcome in men with non-obstructive azoospermia with previous failed sperm retrievals. BJU Int 2015; 116: 460 - 5.
30. 30. Seo JT, Ko WJ. Predictive factors of successful testicular sperm recovery in non-obstructive azoospermia patients. Int J Androl 2001; 24: 306 - 10.