Investigations on the Factors Predicting the Results of Testis Sperm Extraction

Hong, Young Kwon; Shin, Jae Seop; Lee, Woo Sik

Abstract

PURPOSE: Testis sperm extraction and intracytoplasmic sperm injection(TESE-ICSI) has been widely used for the treatment of non-obstructive azoospermia and obstructive azoospermia which cannot be corrected by any other surgical method. We evaluate the results of TESE between groups of obstructive and non-obstructive azoospermia and determine whether there is a significant relationship between the testicular histology, biophysical and endocrine profiles, and the results of TESE in the non-obstructive azoospermia group.
MATERIALS AND METHODS
Between 1997 and 1998, a total of 64 patients underwent TESE procedures, including 23 patients with non-obstructive azoospermia and 41 with obstructive azoospermia, who were beyond the reach of surgical correction and microsurgical epididymal sperm aspiration(MESA). We compared TESE results between two groups. We investigated the factors predicting the results of TESE and tried to correlate the results with biophysical, endocrine profiles and testicular histology.
RESULTS
Non-obstructive azoospermia group had significantly smaller testes, fewer motile sperm, and lower sperm retrieval rate than obstructive group. Statistically significant differences were detected in plasma FSH, LH, and testis volume according to different histology patterns in the non-obstructive azoospermia group. There were no significant differences in age, testis volume, semen volume, plasma FSH, LH, and testis histology between the patients with successful and failed sperm retrieval in the non-obstructive azoospermia group.
CONCLUSIONS
Obstructive azoospermia group is expected to have better chance of pregnancy than non-obstructive azoospermia group due to a difference of sperm retrieval rate. In non-obstructive azoospermia group, sperm retrieval has poor correlations with biophysical and endocrine profiles, and with histological patterns. No single variable can provide a perfect discrimination between the groups with successful and failed TESE. TESE should be performed in carefully selected cases until a reliable criteria predicting the TESE result is established.