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Chapter 9 - Predictors of Positive Surgical Sperm Retrieval in Azoospermic Males

Evaluation of Clinical, Laboratory, and Histopathologic Factors

from Part II - Sperm Retrieval

Published online by Cambridge University Press:  09 April 2021

By
Kareim Khalafalla ,
Ahmed H. Almalki ,
Ahmad Majzoub  and
Sandro C. Esteves
Edited by
Ashok Agarwal ,
Ahmad Majzoub  and
Sandro C. Esteves
Ashok Agarwal
Affiliation:
The Cleveland Clinic Foundation, Cleveland, OH, USA
Ahmad Majzoub
Affiliation:
Hamad Medical Corporation, Doha, Qatar
Sandro C. Esteves
Affiliation:
Andrology & Human Reproduction Clinic, Sao Paulo, Brazil
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Summary

Extensive research has been conducted in search of factors that can predict the likelihood of successful testicular sperm retrieval in nonobstructive azoospermia patients. Clinical factors such as patient age, testicular volume, presence of varicocele, cryptorchidism, and Klinefelter syndrome; laboratory factors such as serum FSH level, inhibin B level, and presence of genetic disturbances; and the histopathologic pattern of testicular tissue have all been investigated in the literature. Of all the above-mentioned factors, the histopathologic pattern appears to be most influential in predicting surgical sperm retrieval outcome.

Keywords

nonobstructive azoospermiahistopathologyoutcome prediction
Type
Chapter
Information
Manual of Sperm Retrieval and Preparation in Human Assisted Reproduction , pp. 75 - 85
Publisher: Cambridge University Press
Print publication year: 2021

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References

Willott, GM. Frequency of azoospermia. Forensic Sci Int 1982;20:9–10.Google Scholar
Jarow, JP, Espeland, MA, Lipshultz, LI. Evaluation of the azoospermic patient. J Urol 1989;142:62–65.CrossRefGoogle ScholarPubMed
Esteves, SC. Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl 2015;17(3):459–470.Google Scholar
Craft, I, Tsirigotis, M, Courtauld, E, Farrer-Brown, G. Testicular needle aspiration as an alternative to biopsy for the assessment of spermatogenesis. Hum Reprod 1997;12:1483–1487.Google Scholar
Ishikawa, T, Nose, R, Yamaguchi, K, et al. Learning curves of microdissection testicular sperm extraction for nonobstructive azoospermia. Fertil Steril 2010;94:1008–1011.CrossRefGoogle ScholarPubMed
Okada, H, Dobashi, M, Yamazaki, T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol 2002;168:1063–1067.Google Scholar
Ramasamy, R, Yagan, N, Schlegel, PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65:1190–1194.Google Scholar
Tsujimura, A, Matsumiya, K, Miyagawa, Y, et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol 2004;172:1944–1947.CrossRefGoogle ScholarPubMed
Esteves, SC, Miyaoka, R, Agarwal, A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo) 2011;66:691–700. Erratum in: Clinics (Sao Paulo) 2012;67:203.CrossRefGoogle ScholarPubMed
Corona, G, Pizzocaro, A, Lanfranco, F, et al. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update 2017;23:265–275.Google Scholar
Garolla, A, Selice, R, Menegazzo, M, et al. Novel insights on testicular volume and testosterone replacement therapy in Klinefelter patients undergoing testicular sperm extraction: a retrospective clinical study. Clin Endocrinol (Oxf) 2018;88:711–718.Google Scholar
Schlegel, PN. Nonobstructive azoospermia: a revolutionary surgical approach and results. Semin Reprod Med 2009;27:165–170.CrossRefGoogle ScholarPubMed
Ramasamy, R, Padilla, WO, Osterberg, EC, et al. A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 2013;189(2):638–642Google Scholar
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(4 Pt 1):1287–1290.Google Scholar
Esteves, SC, Miyaoka, R, Roque, M, Agrawal, A. Outcome of varicocele repair in men with nonobstructive azoospermia: systemic review and meta-analysis. Asian J Androl 2016;18:246–253.Google Scholar
Klonoff-Cohen, HS, Natarajan, L. The effect of advancing paternal age on pregnancy and live birth rates in couples undergoing in vitro fertilization or gamete intrafallopian transfer. Am J Obstet Gynecol 2004;191:507–514.Google Scholar
Aitken, RJ, Baker, MA Oxidative stress, sperm survival and fertility control. Mol Cell Endocrinol 2006;250:66–69.Google Scholar
Evenson, DP, Wixon, R Clinical aspects of sperm DNA fragmentation detection and male infertility. Theriogenology 2006;65:979–991.CrossRefGoogle ScholarPubMed
Belloc, S, Cohen-Bacrie, P, Benkhalifa, M, et al. Effect of maternal and paternal age on pregnancy and miscarriage rates after intrauterine insemination. Reprod Biomed Online 2008;17(3):392–397.CrossRefGoogle ScholarPubMed
Frattarelli, JL, Miller, KA, Miller, BT, Elkind-Hirsch, K, Scott, RT Jr. Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles. Fertil Steril 2008;90(1):97–103.Google Scholar
Ramasamy, R, Trivedi, NN, Reifsnyder, JE, et al. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction. Fertil Steril 2014;101:653–655.Google Scholar
Enatsu, N, Miyake, H, Chiba, K, Fujisawa, M. Predictive factors of successful sperm retrieval on microdissection testicular sperm extraction in Japanese men. Reprod Med Biol 2016;15:29–33.Google Scholar
Li, H, Chen, LP, Yang, J, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl 2018;20(1):30–36.Google ScholarPubMed
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(1):175–178.Google Scholar
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(2):590–593.CrossRefGoogle Scholar
Chen, SC, Hsieh, JT, Yu, HJ, Chang, HC. Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol 2010;8:108.CrossRefGoogle ScholarPubMed
Yang, Q, Huang, YP, Wang, HX, et al. Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia: a systematic review and meta-analysis. Asian J Androl 2015;17(2):281–284.Google ScholarPubMed
Bohring, C, Schroeder-Printzen, I, Weidner, W, Krause, W. Serum levels of inhibin B and follicle-stimulating hormone may predict successful sperm retrieval in men with azoospermia who are undergoing testicular sperm extraction. Fertil Steril 2002;78(6):1195–1198.Google Scholar
Ballesca, JL, Balasch, J, Calafell, JM, et al. Serum inhibin B determination is predictive of successful testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2000;15(8):1734–1738.Google Scholar
Tunc, L, Kirac, M, Gurocak, S, 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):629–635.Google Scholar
Vernaeve, V, Tournaye, H, Schiettecatte, J, et al. Serum inhibin B cannot predict testicular sperm retrieval in patients with non-obstructive azoospermia. Hum Reprod 2002;17:971–976.Google Scholar
Shefi, S, Turek, PJ. Sex chromosome abnormalities and male infertility: a clinical perspective. In: De Jonge, C, Barrat, C (eds.) The Sperm Cell Production, Maturation, Fertilization, Regeneration. Cambridge University Press, Cambridge, 2006, pp. 261–278.Google Scholar
Stahl, PJ, Masson, P, Mielnik, A, et al. A decade of experience emphasizes that testing for Y microdeletions is essential in American men with azoospermia and severe oligozoospermia. Fertil Steril 2010;94(5):1753–1756.Google Scholar
Ramasamy, R, Yagan, N, Schlegel, PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65(6):1190–1194.CrossRefGoogle Scholar
Esteves, SC. Microdissection testicular sperm extraction (micro-TESE) as a sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects. Int Braz J Urol 2013;39(3):440.CrossRefGoogle ScholarPubMed
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):1099–1103.Google Scholar
Meng, MV, Cha, IM, Ljung, BM, Turek, PJ. Relationship between classic histological pattern and sperm findings on fine needle aspiration map in infertile men. Hum Reprod 2000;15(9):1973–1977.CrossRefGoogle ScholarPubMed
Glina, S, Soares, JB, Antunes, N Jr., et al. Testicular histopathological diagnosis as a predictive factor for retrieving spermatozoa for ICSI in non-obstructive azoospermic patients. Int Braz J Urol 2005;31(4):338–341.CrossRefGoogle ScholarPubMed
Ramasamy, R, Schlegel, PN. Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval. J Urology 2007;177(4):1447–1449.Google Scholar
Esteves, SC, Agarwal, A. Re: Sperm retrieval rates and intracytoplasmic sperm injection outcomes for men with non-obstructive azoospermia and the health of resulting offspring. Asian J Androl 2014;16(4):642.Google Scholar
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(1):54–58.Google Scholar
Moein, MR, Tabibnejad, N, Ghasemzadeh, J. Beneficial effect of tamoxifen on sperm recovery in infertile men with nonobstructive azoospermia. Andrologia 2012;44(1):194–198.Google Scholar
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–E114.Google Scholar
Shiraishi, K, Ohmi, C, Shimabukuro, T, Matsuyama, H. Human chorionic gonadotropin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia. Hum Reprod 2012;27:331–339.Google Scholar
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;188:532–536.Google Scholar
Bojesen, A, Juul, S, Gravholt, CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab 2003;88(2):622–626.CrossRefGoogle ScholarPubMed
Friedler, S, Raziel, A, Strassburger, D, et al. Outcome of ICSI using fresh and cryopreserved–thawed testicular spermatozoa in patients with non-mosaic Klinefelter’s syndrome. Hum Reprod 2001;16(12):2616–2620.CrossRefGoogle ScholarPubMed
Lanfranco, F, Kamischke, A, Zitzmann, M, Nieschlag, E. Klinefelter’s syndrome. Lancet 2004;364:273–283.Google Scholar
Bonomi, M, Rochira, V, Pasquali, D, et al. Klinefelter syndrome (KS): genetics, clinical phenotype and hypogonadism. J Endocrinol Invest 2017;40:123–134.CrossRefGoogle ScholarPubMed
Forti, G, Corona, G, Vignozzi, L, Krausz, C, Maggi, M Klinefelter’s syndrome: a clinical and therapeutical update. Sexual Dev 2010;4:249–258.Google Scholar
Franik, S, Hoeijmakers, Y, D’Hauwers, K, et al. Klinefelter syndrome and fertility: sperm preservation should not be offered to children with Klinefelter syndrome. Hum Reprod 2016;31:1952–1959.Google Scholar
Hamada, AJ, Esteves, SC, Agarwal, A. A comprehensive review of genetics and genetic testing in azoospermia. Clinics (Sao Paulo) 2013;68(1):39–60.CrossRefGoogle ScholarPubMed
Foresta, C, Galeazzi, C, Bettalla, A, et al. Analysis of meiosis in intratesticular germ cells from subjects affected by classic Klinefelter’s syndrome. J Clin Endocrinol Metab 1999;84:3807–3810.Google Scholar
Sciurano, RB, Luna Hisano, CV, Rahn, MI, et al. Focal spermatogenesis originates in euploid germ cells in classical Klinefelter patients. Hum Reprod 2009;24:2353–2361.CrossRefGoogle ScholarPubMed
Ferhi, K, Avakian, R, Griveau, JF, Guille, F. Age as only predictive factor for successful sperm recovery in patients with Klinefelter’s syndrome. Andrologia 2009;41:84–87.Google Scholar
Ramasamy, R, Ricci, JA, Palermo, GD, et al. Successful fertility treatment for Klinefelter’s syndrome. J Urol 2009;182:1108–1113.Google Scholar
Bakircioglu, ME, Ulug, U, Erden, HF. Klinefelter syndrome: does it confer a bad prognosis in treatment of nonobstructive azoospermia?. Fertil Steril 2011;95:1696–1699.Google Scholar
Plotton, I, Giscard d’Estaing, S, Cuzin, B, et al. Preliminary results of a prospective study of testicular sperm extraction in young versus adult patients with nonmosaic 47,XXY Klinefelter syndrome. J Clin Endocrinol Metab 2015;100:961–967.Google Scholar
Mehta, A, Bolyakov, A, Roosma, J, Schlegel, PN, Paduch, DA. Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor. Fertil Steril 2013;100:970–974.Google Scholar
Sabbaghian, M, Modarresi, T, Hosseinifar, et al. Comparison of sperm retrieval and intracytoplasmic sperm injection outcome in patients with and without Klinefelter syndrome. Urology 2014;83:107–110.Google Scholar
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;92:590–593.Google Scholar
Ramasamy, R, Ricci, JA, Palermo, GD, et al. Successful fertility treatment for Klinefelter’s syndrome. J Urol 2009;182:1108–1113.Google Scholar
Garrone, G, Liguori, R. Distopias testiculares e malformacoes genitais. In: Nardozza, A Jr, Filho, Zerati Borges, M dos Reis, R (eds.) Urologia Fundamental. Plamark, Sao Paulo, 2010, pp. 383–389.Google Scholar
Wiser, A, Raviv, G, Weissenberg, R, et al. Does age at orchidopexy impact on the results of testicular sperm extraction?. Reprod Biomed Online 2009;19(6):778–783.Google Scholar
Glina, S, Vieira, M. Prognostic factors for sperm retrieval in non-obstructive azoospermia. Clinics 2013;68(S1):121–124.Google Scholar
Walsh, TJ, Wu, AK, Croughan, MS, Turek, PJ. Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele. Fertil Steril 2009;91:826–830.Google Scholar
Esteves, SC, Glina, S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol 2005;31:541–548.Google Scholar
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(1):71–75.Google Scholar
Inci, K, Hascicek, M, Kara, O, et al. Sperm retrieval and intracytoplasmic sperm injection in men with nonobstructive azoospermia, and treated and untreated varicocele. J Urology 2009;182(4):1500–1504.Google Scholar
Schlegel, PN, Kaufmann, J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril 2004;81(6):1585–1588.Google Scholar
Berookhim, BM, Palermo, GD, Zaninovic, N, Rosenwaks, Z, Schlegel, PN. Microdissection testicular sperm extraction in men with Sertoli cell–only testicular histology. Fertil Steril 2014;102:1282–1286.Google Scholar
Devroey, P, Liu, J, Nagy, Z, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 1995;10(6):1457–1460.Google Scholar
Tsujimura, A, Matsumiya, K, Miyagawa, Y, et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol 2004;172(5 Pt 1):1944–1947.Google Scholar
Marconi, M, Keudel, A, Diemer, T, et al. Combined trifocal and microsurgical testicular sperm extraction is the best technique for testicular sperm retrieval in “low-chance” nonobstructive azoospermia. Eur Urol 2012;62:713.Google Scholar
Bromage, SJ, Falconer, DA, Lieberman, BA, et al. Sperm retrieval rates in subgroups of primary azoospermic males. Eur Urol 2007;51:534.Google Scholar
Ziaee, SA, Ezzatnegad, M, Nowroozi, M, et al. Prediction of successful sperm retrieval in patients with nonobstructive azoospermia. Urol J 2006;3:92.Google Scholar
Ezeh, UI, Moore, HD, Cooke, ID. A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non‑obstructive azoospermia. Hum Reprod 1998;13:3075–3080.Google Scholar
Jarvi, K, Lo, K, Fischer, A, et al. CUA Guideline: the workup of azoospermic males. Can Urol Assoc J 2010;4:163–167.Google Scholar
Deffieux, X, Antoine, JM. Inhibins, activins and anti-Mullerian hormone: structure, signalling pathways, roles and predictive value in reproductive medicine. Gynecol Obstet Fertil 2003;31(11):900–911.Google Scholar
Mitchell, V, Boitrelle, F, Pigny, P, et al. Seminal plasma levels of anti-Mullerian hormone and inhibin B are not predictive of testicular sperm retrieval in nonobstructive azoospermia: a study of 139 men. Fertil Steril 2010;94(6):2147–2150.Google Scholar
Blagosklonova, O, Fellmann, F, Clavequin, MC, Roux, C, Bresson, JL. AZFa deletions in Sertoli cell-only syndrome: a retrospective study. Mol Hum Reprod 2000;6:795–799.CrossRefGoogle ScholarPubMed
Gonçalves, C, Cunha, M, Rocha, E, et al. Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia. Asian J Androl 2017;19(3):338–345Google Scholar
Miyaoka, R, Orosz, JE, Achermann, AP, Esteves, SC. Methods of surgical sperm extraction and implications for assisted reproductive technology success. Panminerva Med 2019;61(2):164–177.Google Scholar
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;2:20–24.Google Scholar
Yukselten, Y, Aydos, OSE, Sunguroglu, A, Aydos, K. Investigation of CD133 and CD24 as candidate azoospermia markers and their relationship with spermatogenesis defects. Gene 2019;706:211–221.Google Scholar
Aydos, OS, Yukselten, Y, Ozkavukcu, S, Sunguroglu, A, Aydos, K. ADAMTS1 and ADAMTS5 metalloproteases produced by Sertoli cells: a potential diagnostic marker in azoospermia. Syst Biol Reprod Med 2019;65(1):29–38.CrossRefGoogle ScholarPubMed
Cao, C, Wen, Y, Wang, X, et al. Testicular piRNA profile comparison between successful and unsuccessful micro-TESE retrieval in NOA patients. J Assist Reprod Genet 2018;35(5):801–808.CrossRefGoogle ScholarPubMed

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