ABSTRACT
INTRODUCTION@#To evaluate the sperm retrieval rate and factors influencing its success among patients who undergo conventional or microsurgical testicular sperm extraction (TESE) for non-obstructive azoospermia.@*METHODS@#Data were from 223 consecutive patients who underwent conventional or microsurgical TESE from August 2011 to January 2021 under two urologists of the center. Data regarding age, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, testicular size, histopathology, surgical technique, and sperm retrieval were collected. Patients with obstructive azoospermia, repeated TESE procedure, and those who underwent TESE for oncofertility were excluded. Using simple logistic regression analysis, the relationship of the different factors to successful sperm retrieval was computed as odds ratio.@*RESULTS@#The overall surgical sperm retrieval rate was found to be 65.71%. The odds ratio of successful sperm retrieval were 1.04 (95% CI 1.00-1.09) for age, 0.94 (95% CI 0.91-0.97) for FSH, 0.93 (95% CI 0.87-0.99) for LH, 1.24 (95% CI 0.99-1.55) for testosterone, and 0.93 (95% CI 0.88-0.98) for estradiol. Decreased testicular size was also associated significantly with lower sperm retrieval rate (OR 0.22, 95% CI 0.09-0.56). Histopathologic pattern and surgical technique were also significantly associated with successful sperm retrieval.@*CONCLUSION@#The surgical sperm retrieval rate in this institution is comparable to the global surgical sperm retrieval rate. Age, FSH, LH, estradiol, testicular size, histopathologic pattern and surgical technique were found to have significant association to successful surgical sperm retrieval.
ABSTRACT
@#Testicular sperm extraction (TESE) allows for the possibility of intracytoplasmic sperm injection(ICSI) to achieve fertility but is an invasive procedure, and failed testicular sperm extraction hasbrought significant emotional and financial consequences to couples.@*OBJECTIVE@#This study aims to determine the relationship of pre-operative work-up variables such asage, FSH, LH, total testosterone in the success or failure of TESE in patients by 2 urologists with non-obstructive azoospermia in St. Luke's Medical Center-Global City.@*MATERIALS AND METHODS@#This is a retrospective chart review of patients presenting with infertility,diagnosed to have non-obstructive azoospermia and underwent conventional TESE from 2012 to2016 at St. Luke's Medical Center-Global City. Patients were adult males presenting with infertilityundergoing conventional TESE, known to have non-obstructive azoospermia. TESE outcomes of 46patients with complete parametric laboratory exams warranted for this study were used for statisticalanalysis.@*RESULTS@#T-test results showed no sufficient evidence to conclude that there is significant difference inmean age (p-value = 0.509), mean LH (p-value = 0.549), mean FSH (p-value = 0.81), and totaltestosterone (p-value = 0.824) between patients who had successful and failed TESE. Fisher's exacttest showed that most patients (90.3%) who have successful TESE outcome have normal FSH values.Logistic regression results showed no sufficient evidence to conclude that there is significantrelationship between TESE outcome and age (p-value = 0.503), LH (p-value = 0.542), FSH (p-value= 0.098), and TT (p-value = 0.819). Patients with normal FSH values are 6.22 times more likely tohave successful TESE outcomes compared to patients with elevated FSH values. However, logisticregression results showed no sufficient evidence to conclude that there is significant relationshipbetween successful TESE outcome and normal LH values (OR = 2.0, p-value = 0.493).@*CONCLUSION@#The preoperative factors for predicting success and failure of sperm retrieval duringTESE, including total testosterone, FSH and LH levels, were examined in this study, may not fullygive an estimation of the chances of obtaining spermatozoa in patients with NOA. Accordingly, thecombination and simultaneous interpretation of the other factors not present in this study, such astesticular volume, histopathological patterns, and karyotyping, would likely help to provide a moreaccurate prediction of success and failure and subsequently help the clinician to pursue the appropriatemethods of treatment for these patients.