Jsmc-10295
SURGICAL SPERM RETRIEVAL IN AZOOSPERMIA: OUTCOME AND PREDICTIVE FACTORS
Shyaw M. Ahmed a, Lusan A. Arkawazi b, Kawa A. Mahmood c, and Ismaeel H.A. Aghaways a
a Dept. of Surgery-Urology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq.
b Dept. of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq.
c Dept. of Radiology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq.
Submitted: 1/7/2020; Accepted: 22/11/2020; Published: 21/6/2021
DOI Link: https://doi.org/10.17656/jsmc.10295
ABSTRACT
Background
Before conducting any invasive surgical sperm retrieval in men with azoospermia, it is worth looking at certain factors to predict the chance of finding viable sperm eligible for Intracytoplasmic Sperm Injection.
Objectives
Evaluating the outcome of percutaneous testicular sperm aspiration in men with azoospermia and the predictive value of serum Follicular Stimulating Hormone (FSH), testicular volume, and testicular strain elastography on the sperm retrieval rate
Methods
Cross-sectional prospective study on 73 men with azoospermia who have had their testicular volume and serum FSH measured before conducting percutaneous sperm aspiration. Fifteen men were also recruited to undergo testicular elastography. Age, FSH, testicular volume, and strain ratio on elastography were correlated with the outcome of sperm retrieval.
Results
Mean age was 36 years (range 19-69), 48% of them have had positive sperm retrieval. Twenty-five cycles of Intracytoplasmic Sperm Injection were performed, 8 (32%) have had positive β-hCG test and 4 (16%) live-birth rates. Serum FSH was the only predictive factor of percutaneous sperm retrieval (p=0.013) on multivariate analysis. The strain ratio was shown to be significantly different between men with negative and positive sperm aspirations (p=0.02).
Conclusion
Percutaneous testicular sperm aspiration has a satisfactory retrieval rate in men with azoospermia. A combination of serum FSH and testicular strain elastography seems a promising tool that can potentially be used as guidance for predicting the outcome of surgical sperm retrieval.
KEYWORDS
Azoospermia, Surgical sperm retrieval, Percutaneous TESA, Ultrasound Elastography.
References
1. Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. The Journal of Urology. 1989;142(1):62-5.
2. Devroey P, Liu J, Nagy Z, Tournaye H, Silber SJ, Van Steirteghem ACJF, et al. Normal fertilization of human oocytes after testicular sperm extraction and intracytoplasmic sperm injection. Fertility and Sterility. 1994;62(3):639-41.
3. Glander HJ, Horn LC, Dorschner W, Paasch U, Kratzsch J. Probability to retrieve testicular spermatozoa in azoospermic patients. Asian Journal of Andrology. 2000;2(3):199-206.
4. Tunc L, Kırac M, Gurocak S, Yucel A, Kupeli B, Alkıbay T, 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? International Urology and Nephrology. 2006;38(3-4):629-35.
5. Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU International. 2013;111(3):492-9.
6. Sousa M, Cremades N, Silva J, Oliveira C, Ferraz L, da Silva JT, et al. Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen–thawed sperm and spermatids. Human Reproduction. 2002;17(7):1800-10.
7. Aydin T, Sofikerim M, Yucel B, Karadag M, Tokat F. Gynaecology. Effects of testicular histopathology on sperm retrieval rates and ICSI results in non-obstructive azoospermia. Journal of obstetrics and gynaecology. 2015;35(8):829-31.
8. Oates RD. The genetic basis of male reproductive failure. The Urologic clinics of North America. 2008;35(2):257-70.
9. Yang J, Liu J, Zou X, Yuan Y, Xiao R, Wu G, et al. Sperm retrieval and the predictive parameter of non-obstructive azoospermia: a meta-analysis of literatures 1990 to 2008. Zhonghua Yi Xue Za Zhi.2008; 88(30):2131-5.
10. Yavuz A, Yokus A, Taken K, Batur A, Ozgokce M, Arslan H. Reliability of testicular stiffness quantification using shear wave elastography in predicting male fertility: a preliminary prospective study. Medical Ultrasonography. 2018;20(2):141-7.
11. Ozturk A, Grajo JR, Dhyani M, Anthony BW, Samir AE. Principles of ultrasound elastography. Abdominal Radiology. 2018;43(4):773-85.
12. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrasonic imaging. 1991;13(2):111-34.
13. Sigrist RM, Liau J, El Kaffas A, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics. 2017;7(5):1303.
14. Garra BS. Elastography: history, principles, and technique comparison. Abdominal imaging. 2015;40(4):680-97.
15. Pallwein L, Steiner H, Akkad T, Bartsch G, Frauscher F. Real-time elastography for evaluation of testicular masses: initial experience. Radiology. 2006;5(2):96.
16. Marsaud A, Durand M, Raffaelli C, Carpentier X, Rouscoff Y, Tibi B, et al. Elastography shows promise in testicular cancer detection. Progres en urologie. 2015;25(2):75-82.
17. Patel KV, Huang DY, Sidhu PS. Metachronous bilateral segmental testicular infarction: multi-parametric ultrasound imaging with grey-scale ultrasound, Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE). Journal of Ultrasound. 2014;17(3):233-8.
18. Sun Z, Xie M, Xiang F, Song Y, Yu C, Zhang Y, et al. Utility of real-time shear wave elastography in the assessment of testicular torsion. PloS One. 2015; 10(9): e0138523.
19. Schurich M, Aigner F, Frauscher F, Pallwein-PrettnerL. Gynecology, Biology R. The role of ultrasound in assessment of male fertility. European Journal of obstetrics, gynaecology and Reproductive Biology. 2009;144 Suppl1(Suppl 1):S192-S8.
20. Li M, Du J, Wang ZQ, Li FH. The value of sonoelastography scores and the strain ratio in differential diagnosis of azoospermia. The Journal of Urology. 2012;188(5):1861-6.
21. Cooper TG, Noonan E, Von Eckardstein S, Auger J, Baker H, Behre HM, et al. World Health Organization reference values for human semen characteristics. Human Reproduction Update. 2010;16(3):231-45.
22. Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007;69(1):152-7.
23. Gottschalk-Sabag S, Glick T, Weiss DB. Fine needle aspiration of the testis and correlation with testicular open biopsy. Acta Cytologica. 1993;37(1):67-72.
24. Tournaye H. Update on surgical sperm recovery–the European view. Human Fertility. 2010;13(4):242-6.
25. Cissen M, Meijerink A, D'Hauwers K, Meissner A, Van Der Weide N, Mochtar M, et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Human Reproduction. 2016;31(9):1934-41.
26. Ramasamy R, Padilla WO, Osterberg EC, Srivastava A, Reifsnyder JE, Niederberger C, et al. A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. The Journal of urology. 2013;189(2):638-42.
27. Yang Q, Huang Y-P, Wang H-X, Hu K, Wang Y-X, Huang Y-R, et al. Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia: a systematic review and meta-analysis. Asian journal of andrology. 2015;17(2):281.
28. Boitrelle F, Robin G, Marcelli F, Albert M, Leroy-Martin B, Dewailly D, et al. A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study. Human reproduction. 2011;26(12):3215-21.
29. Salehi P, Derakhshan-Horeh M, Nadeali Z, Hosseinzadeh M, Sadeghi E, Izadpanahi MH, et al. Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients. Clinical and experimental reproductive medicine. 2017;44(1):22.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.