ISSN 2149-3235 | E-ISSN 2149-3057
1 Department of Urology, Ota-Jinemed Hospital, İstanbul, Turkey  
2 Department of Gynocology and Obstetrics, OTA-Jinemed Hospital, İstanbul, Turkey  
3 Department of Embriyology, OTA-Jinemed Hospital, İstanbul, Turkey  
Turk J Urol ; : -

Abstract

 

Objective: The absence of any sperm in the ejaculate is called azoospermia and it is detected in 1% of males and 10-15% of those with infertility complaints. Azoospermia may be due to obstructive (OA) and non-obstructive (NOA) causes. Today, healthy pregnancies can be achieved in azoospermic patients by intracytoplasmic sperm injection (ICSI) performed using sperm retrieved from microscopic testicular sperm extraction (m-TESE). In this study, we examined the sperm retrieval rates with m-TESE in azoospermic patients, the results of ICSI in OA and NOA patients with sperm and the underlying testicular pathologies in patients without sperm.

 

Material and methods: Patients who underwent m-TESE at IVF unit of our hospital between January 2005 and April 2017 were retrospectively reviewed. A total of 342 azoospermic patients (117 OA and 225 NOA cases) with regular follow-up were included in the study. In these cases, sperm retrieval and clinical pregnancy rates after ICSI were compared.

 

Results: Mean duration of infertility was 28.2±7.8 months in the OA group, 34.2±5.4 years in patients, 30.3±2.9 years in spouses. In the NOA group, the mean duration of infertility was 30.3±6.5 months, the mean age of the patients was 35.3±3.4, and the mean age of the spouses was 30.6±3.3 years. In 68.9% of the cases, the therapeutic indication was male factor alone, while 31.1% had female factor infertility. In the OA group, 68.9% of the cases had only male factor infertility, while 31.1% of them had also female factor infertility. In the NOA group, 65.4% of the cases had only male factor infertility, and female factor was found in 34.6% of the cases. OA patients had a mean serum FSH level of 11.7±3.7 mIU/mL and mean testicular volume of 12.5±2.6 mL, NOA patients had a mean serum FSH level of 13.7±5.4 mIU/mL and mean testicular volume of 9.8±3.4 mL. In the m-TESE procedure, motile sperm was found in all of the OA patients and in 52.4% (118/225) of the NOA patients. Clinical pregnancy rate in the OA group was 29.9% (35/117) and live birth rate was 25.6% (30/117). In the NOA group, the clinical pregnancy rate was 27.1% (32/118) and the live birth rate was 23.7% (27/118). Histopathologic evaluation was made in 107 cases in the NOA group with no testicular sperm, revealing that 59 cases with germ-cell aplasia (sertoli-cell only syndrome), 42 cases with maturation arrest, and 6 cases with hypospermatogenesis. Postoperative hematoma developed in 3 of m-TESE cases and subsided with conservative treatment.

 

Conclusion: If motile sperm is retrieved with m-TESE application in azoospermic patients, pregnancy resulting in one live birth in about 4 couples who undergo ICSI application can be achieved. In the presence of motile sperm, live birth rates are similar between OA and NOA case with very low complication rates.

 

Cite this article as: Erdem E, Karacan M, Çebi Z, Uluğ M, Arvas A, Çamlıbel T. Results of Intracytoplasmic sperm injection (ICSI) performed with sperm retrieved by microscopic testicular sperm extraction (m-TESE) in azoospermic patients. Turk J Urol 2017; DOI: 10.5152/tud.2018.85282

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