Fertility outcomes in microdissection testicular sperm extraction for non-obstructive azoospermia

Background: The objective of this study was to evaluate outcome of micro dissection testicular sperm extraction (micro TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non-obstructive azoospermia (NOA).Methods: We retrospectively analysed data of 96 consecutive patients with clinical NOA who were treated with micro TESE by single surgeon, between January 2022 and December 2022, in Lifeline superspeciality hospital Adoor, Kerela. Embryological and clinical outcomes were demonstrated based on ICSI-IVF cycles using fresh or frozen sperms, different etiologies of NOA and various counts of sperms retrieved.Results: 96 men underwent micro TESE and 72.9% (70/96) of them had sperms retrieved. ICSI performed in 64 couples. Of those, 41 reached the stage of embryo transfer (ET). Of the couples who underwent embryo transferred, 18 (43%) resulted in biochemical pregnancies and 7 (17%) clinical pregnancies. There was a significant difference in the testicular volume and serum FSH levels between micro-TESE positive and negative groups (p=0.000). Retrieval rates were higher in group of men with normal testicular volume and FSH<12. Clinical pregnancy rate was around 11% in couples who had sperms retrieved by micro TESE. The sperm retrieval rates were higher in men with age <40 years. Similarly younger the female age more was the pregnancy rate. Out of various etiologies idiopathic NOA and Klinefelter syndrome had better sperm retrieval rate in our study which was statistically significant. Total fertilization rate and blasts rates were 79.7% and 51.6% out of ICSI.Conclusions: Microdissection testicular sperm extraction is an effective treatment for NOA with higher rate of sperm retrieval and pregnancy rate. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.

Relationship between serum reproductive hormones and sperm parameters and surgical outcomes in Micro-TESE / 现代泌尿外科杂志

【Objective】 To investigate the relationship between serum reproductive hormones and sperm parameters and outcomes of micro-testicular sperm extraction (Micro-TESE). 【Methods】 Clinical data of 1 091 patients treated in our hospital during Jan. and Dec.2021 were retrospectively analyzed. According to the sperm concentration,the patients were divided into non-obstructive azoospermia (NOA) group (group A,n=418),normal sperm concentration group (group B,n=615),mild to moderate oligospermia group (group C,n=18),severe oligospermia group (group D,n=18),and obstructive azoospermia group (group E,n=22). In group A,244 cases treated with Micro-TESE were grouped into the sperm-acquired group (Micro-TESE positive group,n=82) and non-sperm-acquired group (Micro-TESE negative group,n=162),and according to the pathological types of testicular tissue,the patients were divided into normal testicular tissue with hypospermatogenesis group (HYPO group,n=129),maturation arrest group (MA group,n=10),and support-only cell syndrome group (SCO group,n=122). Differences in semen parameters and reproductive hormone levels were compared,and relationship between reproductive hormones and sperm parameters and Micro-TESE outcomes was determined with Pearson correlation analysis. 【Results】 In the sperm concentration subgroup,the testicular volume of group A was lower than that of group B and group E (P<0.05); the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in group A were the highest (P<0.05),but the level of testosterone (T) was the lowest (P<0.05); the levels of anti-mullerian hormone (AMH) and serum inhibin B (INHB) in group A were lower than those in group B and group E (P<0.05),the normal sperm morphology rate in group B was higher than that in group A and group E (P<0.05); the percentage of forward moving sperm in group B was the highest (P<0.05). Pearson correlation analysis revealed that sperm concentration,normal sperm morphology rate,and percentage of forward moving sperm were negatively correlated with age,FSH,LH (P<0.05),and positively correlated with testicular volume,T,AMH,and INHB (P<0.05). NOA patients were grouped according to testicular histology and pathology. The INHB in the SCO group was the smallest of the three groups (P<0.05); the FSH and LH levels in the SCO group were higher than those in the MA group (P<0.05),while the 17β-estradiol (E2) levels in the HYPO group were higher than those in the SCO group (P<0.05). NOA patients were grouped according to the results of Micro-TESE surgical treatment. There was a statistically significant difference in AMH and INHB levels between the Micro-TESE positive and negative groups (P<0.05). The binary logistic regression analysis of factors affecting the Micro-TESE outcomes of NOA patients showed AMH was negatively correlated with the Micro-TESE outcome (OR=0.904,95%CI:0.91-1.08,P<0.05). 【Conclusion】 Age,FSH,LH,AMH,and INHB are correlated with sperm concentration,normal sperm morphology rate,and percentage of forward moving sperm. The INHB level was the lowest in the SCO group. The results of Micro-TESE in patients with NOA can be predicted by serum AMH level.

Sperm retrieval rate of microdissection testicular sperm extraction in patients with non-obstructive azoospermia based on different causes / 现代泌尿外科杂志

【Objective】 To investigate the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (M-TESE) in patients with non-obstructive azoospermia (NOA) caused by different causes. 【Methods】 A retrospective analysis was performed on 225 NOA patients during Jan.2020 and Dec.2022. The relation between SRR and patients’ age,body mass index (BMI),testicular volume,endocrine hormones and different etiological classifications were analyzed. 【Results】 According to whether sperm was obtained by surgery,the patients were divided into two groups,including 107 cases in the sperm group and 118 cases in the non-sperm group. There were no significant differences in patients’ age,testicular volume and levels of endocrine hormones between the two groups (P>0.05). According to the different causes,NOA patients with mumps history,cryptorchidism history,AZFc deletion or Klinefelter syndrome (KS) had higher SRR,while idiopathic NOA patients had the lowest SRR (P<0.05). 【Conclusion】 M-TESE is an effective treatment of NOA. There is no correlation between SRR and patients’ age,MBI,testicular volume and levels of endocrine hormones. NOA caused by different etiological classifications may have different SRR.

Findings of new biomarkers for non-obstructive azoospermia by gene expression profile / 临床检验杂志

Objective To investigate the expression of differential genes in testicular tissue of patients with obstructive and non-ob-structive azoospermia by bioinformatics,and provide new markers for the diagnosis of non-obstructive azoospermia(NOA).Methods The microarray data of azoospermia related genes(GSE45885 and GSE9210)were downloaded from the gene expression comprehensive database(GEO)and analyzed online by GEO2R,and the NOA related differentially expressed genes(DEGs)were obtained.The common DEGs were determined by using Wayne's intersection.GO annotation and KEGG enrichment analysis of DEGs were carried out by using R software.The DEGs-related protein interaction network(PPI)was constructed with STRING.Then,the most significant Hub gene of NOA was screened out by Cytoscape software and visualization was performed.The diagnostic value of Hub gene for NOA was estimated by the receiver operating characteristics(ROC)curve and verified in GSE145467 data set.Results A total of 83 DEGs were obtained,of which 78 were down-regulated and 5 were up-regulated.GO enrichment analysis showed that DEGs was involved in biological processes(BP),including the development and differentiation of sperm cells,development of germ cells,assembly of motor cilia,etc.Cell composition(CC)mainly included sperm flagella,motor cilia,acrosome vesicles,spermatogenic nuclei,etc.Molecular function(MF)mainly included structural components,protein binding,heat shock protein binding and so on,which endowed com-pressive strength for extracellular matrix.KEGG-related pathways were involved in longevity regulation pathways,cell cycle and apopto-sis,and meiosis of oocytes in multiple species.The five Hub genes closely related to NOA,including SPAG5,CCNB2,AURKC,NCAPH and PTTG1,were screened by PPI network.The ROC curve showed that all the five Hub genes were potential genetic markers of NOA.Conclusion SPAG5,CCNB2,AURKC,NCAPH and PTTG1 genes may play the key role in the development of NOA and may be used as the new biomarkers for NOA.

Outcomes of surgical sperm retrieval for non-obstructive azoospermia: A single-center experience

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.

Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia

ABSTRACT Objective To determine the optimal cut-off value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cut-off value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cut-off value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.

Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Non-obstructive azoospermia (NOA), which is defined as the absence of spermatozoa in the ejaculate secondary to impaired spermatogenesis within the testis, may be caused by a variety of etiologies, including varicocele-induced testicular damage, cryptorchidism, prior testicular torsion, post-pubertal mumps orchitis, gonadotoxic effects from medications, genetic abnormalities, chemotherapy/radiation, and other unknown causes currently classified as idiopathic (Cocuzza et al., 2013). The microdissection testicular sperm extraction (micro-TESE) technique involves a meticulous microsurgical exploration of the testicular parenchyma to identify and selectively extract larger seminiferous tubules that carry a higher probability of complete spermatogenesis (Schlegel, 1999). The Cornell group evaluated the efficacy of micro-TESE in 152 NOA patients with an associated history of cryptorchidism. In their series, spermatozoa were successfully retrieved in 116/181 attempts (64%), and the resulting pregnancy rate was 50% with a delivery rate of 38% (Dabaja and Schlegel, 2013). Franco et al. (2016) described a stepwise micro-TESE approach in NOA patients, which was considered to reduce the cost, time, and effort associated with the surgery. Alrabeeah et al. (2016) further reported that a mini-incision micro-TESE, carried through a 1-cm equatorial testicular incision, can be useful for micro-TESE candidates, particularly in patients with cryptozoospermia. We conducted a retrospective study of 20 consecutive NOA patients with a history of orchidopexy from May 2015 to March 2017.

CEP55 may be a potential therapeutic target for non-obstructive azoospermia with maturation arrest / 南方医科大学学报

OBJECTIVE@#To explore the effect of small interfering RNA (siRNA)-mediated CEP55 gene silencing on the proliferation of mouse spermatogonia.@*METHODS@#Six patients with azoospermia diagnosed to have maturation arrest (3 cases) or normal spermatogenesis (3 cases) based on testicular biopsy between January 1 and December 31, 2017 in our center were examined for differential proteins in the testicular tissue using isobaric tags for relative and absolute quantitation (iTRAQ), and CEP55 was found to differentially expressed between the two groups of patients. We constructed a CEP55 siRNA for transfection in mouse spermatogonia and examined the inhibitory effects on CEP55 expressions using Western blotting and qPCR. The effect of CEP55 gene silencing on the proliferation of mouse spermatogonia was evaluated with CCK8 assay.@*RESULTS@#In the testicular tissues from the 6 patients with azoospermia, iTRAQ combined with LC/MS/MS analysis identified over two hundred differentially expressed proteins, among which CEP55 showed the most significant differential expression between the patients with maturation arrest and those with normal spermatogenesis. The cell transfection experiment showed that compared with the cells transfected with the vehicle or the negative control sequence, the mouse spermatogonia transfected with CEP55 siRNA showed significantly lowered expressions of CEP55 mRNA and protein ( < 0.05) and significantly decreased proliferation rate as shown by CCK8 assay ( < 0.05).@*CONCLUSIONS@#CEP55 may play a key role in spermatogenesis and may serve as a potential therapeutic target for non-obstructive azoospermia with maturation arrest.

Predictive factors of sperm retrieval in non-obstructive azoospermia using conventional Testicular Sperm Extraction (TESE) – A retrospective, single center study

@#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.

Cell suspension examination versus histopathological technique in detecting sperm in the testis tissue of non-obstructive azoospermia patients undergoing testicular sperm aspiration / 中华男科学杂志

<p><b>Objective</b>To explore the clinical selection and application of cell suspension examination (CSE) or histopathological technique (HPT) in detecting sperm in the testis tissue obtained by testicular sperm aspiration (TESA) in patients with non-obstructive azoospermia (NOA).</p><p><b>METHODS</b>Totally, 1 006 NOA patients underwent TESA and their testis tissues were subjected to CSE or HPT for sperm detection. Based on the results of CSE, the testicular tissue samples were divided into groups A (with sperm, n = 567) and B (without sperm, n = 439) and the results were compared with those of HPT.</p><p><b>RESULTS</b>HPT showed 508 cases with but 59 without sperm in group A, and 403 with and 36 without sperm in group B. The consistency rate of CSE with that of HPT was 90.56% (Kappa =0.809), and CSE exhibited a significantly higher rate of sperm detection than HPT (56.36% vs 54.08%, P=0.023).</p><p><b>CONCLUSIONS</b>CSE combined with HPT for detecting sperm in the testis tissue of NOA patients undergoing diagnostic TESA helps clinical diagnosis and treatment. The results of CSE have a decisive significance for assisted reproductive therapy, while those of HPT may provide some definite etiological evidence for drug therapy or surgery.</p>

Micro-dissection testicular sperm extraction for non-obstructive azoospermia patients with the history of secondary testicular injury / 中华男科学杂志

<p><b>Objective</b>To investigate the value of micro- dissection testicular sperm extraction (micro-TESE) in the treatment of non-obstructive azoospermia (NOA) in patients with the history of secondary testicular injury.</p><p><b>METHODS</b>Totally, 121 NOA patients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE (the micro-TESE group) and those with the sperm ejaculated from severe oligospermia patients (sperm concentration <1×10⁶/ml, the ejaculate group). Comparisons were also made between the two groups in the female age, two-pronucleus (2PN) fertilization rate, transferrable embryos on day 3 (D3), D3 high- quality embryos, D14 blood HCG positive rate, embryo implantation rate, and clinical pregnancy rate.</p><p><b>RESULTS</b>Testicular sperm were successfully retrieved by micro-TESE in 86.0% of the patients (104/121), of whom 98.4% had the history of orchitis, 75.5% had been treated surgically for cryptorchidism, and 63.6% had received chemo- or radiotherapy. No statistically significant differences were observed between the micro-TESE and ejaculate groups in the 2PN fertilization rate (59.4% vs 69.3%, P > 0.05), D14 blood HCG positive rate (44.6% vs 57.9%, P > 0.05), embryo implantation rate (31.8 %% vs 32.6%, P > 0.05) and clinical pregnancy rate (41.5% vs 48.7%, P > 0.05). However, the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group (40.5% vs 52.2%,P < 0.05), and so was that of D3 high-quality embryos (32.5% vs 42.1%, P < 0.05).</p><p><b>CONCLUSIONS</b>Micro-TESE can be applied as the first choice for NOA patients with the history of secondary testicular injury, but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro- TESE.</p>

Biomarkers for predicting the outcome of microdissection testicular sperm extraction for non-obstructive azoospermia patients: A systematic review / 中华男科学杂志

Infertility is a common medical condition which affects nearly 15% of the world population. Non-obstructive azoospermia (NOA) is a most challenging problem inducing male infertility and does not respond to the existing medication. Surgery is the primary method for obtaining sperm from NOA patients, but the outcome of testicular sperm extraction is unpredictable preoperatively. Recently, with the development of detection techniques for male infertility, some new biomarkers have come into notice, which may be of some value in predicting the outcome of microdissection testicular sperm extraction (MTSE) and evaluating male infertility. This article presents an overview of the known biomarkers contributive to the prediction of the outcome of MTSE for NOA patients.

Expression of CLAUDIN-11 in the testicular tissue of the patient with non-obstructive azoospermia and its clinical significance / 中华男科学杂志

<p><b>Objective</b>To study the expression of CLAUDIN-11 in the testis tissue of non-obstructive azoospermia (NOA) patients with different severities and investigate its clinical significance.</p><p><b>METHODS</b>Sixty-two NOA patients were divided into a hypospermatogenesis (HS) group (n = 30) and a Sertoli cell only syndrome (SCO) group (n =32). The expression of CLAUDIN-11 in the testicular tissue of the patients was detected by immunohistochemistry, that of CLAUDIN-11 mRNA determined by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and the levels of serum reproductive hormones measured by chemiluminescent immunoassay.</p><p><b>RESULTS</b>Immunohistochemistry showed that the expression of CLAUDIN-11 was mainly in the cytoplasm of the Sertoli cells around the seminiferous tubule wall in the HS group, but diffusely distributed in the membrane of the Sertoli cells in the SCO group. RT-qPCR revealed a significantly lower expression of CLAUDIN-11 mRNA in the HS than in the SCO group (0.008 ± 0.001 vs 0.013 ± 0.002, t = 10.616, P<0.01). The level of serum luteotropic hormone (LH) was also markedly lower in the HS than in the SCO group (［3.62 ± 1.34］ vs ［4.96 ± 3.10］ IU/L, P<0.05) and so was that of follicle-stimulating hormone (FSH) (［5.36 ± 2.80］ vs ［10.65 ± 9.18］ IU/L, P<0.05).</p><p><b>CONCLUSIONS</b>The up-regulated expression of CLAUDIN-11 in Sertoli cells may play an important role in the development and progression of spermatogenic dysfunction in NOA patients.</p>

Analysis study of serum miRNA expression profile in patients with non-obstructive azoospermia / 重庆医学

Objective To analyze the serum miRNA expression levels in non-obstructive azoospermia (NOA) patients and healthy sperm donors.Methods Serum miRNA levels in NOA patients and healthy sperm donors were analyzed by adopting the miRNA expression profiles chip.The data were processed and an alyzed by using the GenePix proV6.0 software to find out the differentially expressed miRNA,then the difference was verified by RQ-PCR,finally the bioinformatic software was utilized to predict the miRNA target gene.Results Compared to healthy sperm donors,71 cases of NOA had miRNAs expression difference,miRNA expression were increased in 47 cases and miRNAs expression was decreased in 24 cases.Moreover,Realtime PCR analysis verified the chip accuracy.The bioinformatic software target gene prediction showed that the potential target gene of these differential miRNA were involved in spermatogenesis.Conclusion The specific miRNA exists in serum miRNA of NOA,which helps to study the molecular mechanism of spermatogenesis.

Microdissection testicular sperm extraction for patients with nonmosaic Klinefelter syndrome: A report of 143 cases / 中华男科学杂志

Objective@#To investigate the clinical application and outcomes of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS).@*METHODS@#A total of 143 nonmosaic KS patients underwent micro-TESE in the Center of Reproductive Medicine of Peking University Third Hospital between July 2012 and August 2016. We analyzed their clinical and follow-up data and evaluated the outcomes.@*RESULTS@#Spermatozoa were successfully retrieved from the testicular tissue in 44.76% (64/143) of the patients, 84.4% (54/64) by unilateral and 15.6% (10/64) by bilateral micro-TESE. Seventy-five of the KS patients were followed up in the years of 2014 and 2015. Of the 34 patients with successful sperm retrieval, 73.52% (25/34) achieved clinical pregnancy and 8 boys and 8 girls were already born in 14 of the 25 cases.@*CONCLUSIONS@#The micro-TESE is a useful method for sperm retrieval in nonmosaic KS patients, with high rates of sperm retrieval, clinical pregnancy, and birth of biological offspring.

Testicular histology does not affect the clinical outcomes of ICSI in men with non-obstructive azoospermia / 中华男科学杂志

Objective@#To investigate whether testicular histology influences the clinical outcomes of intracytoplasmic sperm injection (ICSI) in men with non-obstructive azoospermia (NOA).@*METHODS@#We retrospectively analyzed the clinical data about 73 cases of NOA undergoing ICSI, including 105 ICSI cycles and 79 embryo transfer cycles. The infertility of the patients was attributed to male factors only or both male and female tube factors and the females' age was ≤38 years. Based on testicular histology, we divided the ICSI cycles into three groups: hypospermatogenesis (HS, n = 72), maturation arrest (MA, n = 21) and Sertoli cells only (SCO, n = 12). We recorded and analyzed the age of both the males and females, infertility duration, base follicle-stimulating hormone (FSH) level, dose and days of gonadotropin (Gn) administration, estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (hCG) administration, endometrial thickness, number of metaphase II (MII) oocytes, and rates of fertilization, transferrable embryos, high-quality embryos, clinical pregnancy, and abortion.@*RESULTS@#The rates of fertilization, failed fertilization, transferrable embryos, and high-quality embryos, and the average number of transferred embryos were 67.03% (553/825), 9.52% (10/105), 85.66% (472/551), 35.03% (193/551), and 2.10, respectively, resulting in 44 pregnancies (55.70%) and 42 live births (53.16%), with no birth defects. No statistically significant differences were observed among the HS, MA and SCO groups in the mean age of the men and women, infertility duration, base FSH level, Gn dose, Gn days, E2 and P levels on the hCG day, endometrial thickness, or number of MII oocytes, nor in the rates of fertilization (68.51% vs 64.39% vs 61.45%), transferrable embryos (85.05% vs 90.48% vs 83.05%), or high-quality embryos (33.09% vs 41.67% vs 38.98%). The rates of clinical pregnancy and embryo implantation were higher in the HS (60.00% and 37.61%) and SCO (62.50% and 50.00%) than in the MA group (37.50% and 21.21%), but with no statistically significant differences (P >0.05).@*CONCLUSIONS@#Once testicular sperm is retrieved, desirable clinical outcomes can be achieved in ICSI for NOA patients, which is not affected by testicular histopathology.

Microdissection testicular sperm extraction for patients with non-mosaic Klinefelter's syndrome: An update / 中华男科学杂志

Klinefelter's syndrome (KS) is a most frequent sex chromosomal disorder in males, which is characterized by hypogonadism and infertility. The development of assisted reproductive technology has made it possible for KS males to father children. Microdissection testicular sperm extraction (mTESE) is widely considered to be the best method for sperm retrieval in KS patients. This article presents an overview on mTESE for men with non-mosaic KS in the aspects of its predictors, sperm retrieval rate, operation procedure, preoperative hormonal therapy, and postoperative complications and testosterone reduction.

Trigger effect of hMG and hCG in the treatment of unexplainable non-obstructive azoospermia / 中华男科学杂志

Objective@#To investigate whether the trigger effect of human menopausal gonadotropins (hMG) and human chorionic gonadotropins (hCG) attributes to the treatment of unexplainable non-obstructive azoospermia (NOA).@*METHODS@#We retrospectively analyzed the clinical data about 282 cases of unexplainable NOA treated in the Maternity and Child Health Hospital of Guizhou Province from January 2010 to May 2017. All the patients underwent trigger treatment by intramuscular injection of hMG at 75 IU 3 times a week for 2 weeks, followed by hCG at 2 000 IU twice a week for another 2 weeks, and meanwhile took vitamin E, Levocarnitine and Tamoxifen as an adjunctive therapy. The treatment lasted 3－12 months.@*RESULTS@#Fifty-eight of the 255 patients that completed the treatment were found with sperm in the semen after treatment, all with severe oligoasthenospermia. Forty-seven of the 58 cases received assisted reproductive technology (ART), of which 18 achieved clinical pregnancy. Semen centrifugation revealed no sperm in the other cases, of which 6 were found with epididymal sperm at epididymal and testicular biopsy after treatment and 3 of them achieved clinical pregnancy after ART. Sperm was found in the semen or at epididymal or testicular biopsy in 64 of the patients after treatment, with an effectiveness rate of 25.1%.@*CONCLUSIONS@#Trigger treatment by injection of hMG and hCG combined with adjunctive oral medication has a certain effect on unexplainable NOA.

The analysis study based on 973 azoospermia patients′testicular volume,reproductive hormones and sperm cytological / 国际检验医学杂志

Objective To investigate the correlation between the testicular volume and reproductive hormones level with sperm cytological detection results in azoospermic patients .Methods Based on the WHO male infertility etiology diagnosis classification criteria ,973 azoospermic patients were divided into the obstructive azoospermia (OA ) and non‐obstructive azoospermia (NOA ) . Then NOA was divided into the existing spermatogenic cells type group and non‐existing spermatogenic cells type group according to the sperm spermatogenic cell detection results .The testicular volume and reproductive hormones levels were statistically analyzed and compared among various groups .Results In 973 azoospermia patients ,235 cases were OA (24 .15% ) and 738 cases were NOA (75 .85% ) .There were 410 cases (55 .56% ) of existing spermatogenic cells type and 328 cases(44 .44% ) of non‐existing spermato‐genic cells type .The testicular volume in the existing spermatogenic cells type group and non‐existing spermatogenic cells of NOA was clearly reduced ,the T and T/LH were lower ,while the LH and FSH levels were significantly increased ,the difference between the OA group and the NOA group had statistical difference (P0 .05) .Conclusion The testicular volume and reproductive hormones level are closely related with the detection quantity of sperm cells and the detection of T /LH is helpful for understanding the relation between the function of leydig cells and basement membrane change .

Effects of maternal age on embryo quality and pregnancy outcomes using testicular sperm with intracytoplasmic sperm injection / 대한생식의학회지

OBJECTIVE: The aim of this study was to evaluate the influence of maternal age on fertilization, embryo quality, and clinical pregnancy in patients undergoing intracytoplasmic sperm injection (ICSI) using testicular sperm from partners with azoospermia. METHODS: A total of 416 ICSI cycles using testicular spermatozoa from partners with obstructive azoospermia (OA, n=301) and non-obstructive azoospermia (NOA, n=115) were analyzed. Female patients were divided into the following age groups: 27 to 31 years, 32 to 36 years, and 37 to 41 years. The rates of fertilization, high-quality embryos, clinical pregnancy, and delivery were compared across maternal age groups between the OA and NOA groups. RESULTS: The rates of fertilization and high-quality embryos were not significantly different among the maternal age groups. Similarly, the clinical pregnancy and delivery rates were not significantly different. The fertilization rate was significantly higher in the OA group than in the NOA group (p<0.05). Age-group analysis revealed that the fertilization and high-quality embryo rates were significantly different between the OA and NOA groups in patients aged 27 to 31 years old, but not for the other age groups. Although the clinical pregnancy and delivery rates differed between the OA and NOA groups across all age groups, significant differences were not observed. CONCLUSION: In couples using testicular sperm from male partners with azoospermia, pregnancy and delivery outcomes were not affected by maternal age. However, women older than 37 years using testicular sperm from partners with azoospermia should be advised of the increased incidence of pregnancy failure.