Micro‐testicular sperm extraction outcomes for non‐obstructive azoospermia in a single large clinic in Victoria

• Published in: Australian & New Zealand journal of obstetrics & gynaecology Vol. 62; no. 2; pp. 300 - 305
• Main Authors: Lantsberg, Daniel, Mizrachi, Yossi, Katz, Darren J.
• Format: Journal Article
• Language: English
• Published: Australia 01-04-2022
• Subjects: Azoospermia - etiology; Azoospermia - surgery; azoospermia, non‐obstructive [supplementary concept]; Child; Female; Humans; infertility, male; Male; Pregnancy; reproductive techniques; Retrospective Studies; sperm injections, intracytoplasmic; sperm retrieval; Sperm Retrieval - adverse effects; Spermatozoa - pathology; Victoria; Victoria; sperm retrieval; infertility, male; sperm injections, intracytoplasmic; azoospermia, non-obstructive [supplementary concept]; reproductive techniques
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/ajo.13477

Aims
To evaluate the results of microdissection testicular sperm extraction (micro‐TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non‐obstructive azoospermia (NOA).
Materials and methods
We retrospectively analysed data of 88 consecutive patients with clinical NOA who were treated with micro‐TESE by a single surgeon, between August 2014 and September 2020, in Melbourne, Victoria. Upon a successful sperm retrieval, sperm was either used fresh for ICSI, frozen for future use or both. The outcome measures were sperm retrieval rate (SRR), and in vitro fertilisation (IVF)/ICSI results. Furthermore, SRR was calculated for the predominant causes and histopathological patterns.
Results
The overall SRR was 61.2%. It was significantly higher in patients with a history of cryptorchidism and other childhood diseases (100%) than in the other NOA groups (P < 0.05). Patients with Klinefelter syndrome had a 75% SRR. Among the different types of testicular histology, the highest SRR were noted in patients with complete hyalinisation (100%) and hypospermatogenesis (92.9%), and low with Sertoli cell‐only syndrome (46.3%). The SRR has significantly increased from 33.3% in 2015–2016 to 73.6% in 2019–2020 (P = 0.009). Of the 52 patients with SSR, 47 underwent IVF/ICSI. Fertilisation rate was 42.4%. Twenty‐nine couples achieved at least one good‐quality embryo and had embryo transfer. Nineteen achieved pregnancy (40.4%), and in three patients a miscarriage resulted.
Conclusions
This is the first report from Australia showing that micro‐TESE is an effective treatment for NOA with high SRR. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.