Testicular Sperm Extraction in Non-Obstructive Azoospermic Patients with Sertoli Cell-Only Syndrome Testicular Histology

Year 2024, , 78 - 80, 30.06.2024

Mehmet Vehbi Kayra , Cevahir Özer

https://doi.org/10.36516/jocass.1448280

Abstract

INTRODUCTION: Sertoli cell-only syndrome (SCOS) is a prevalent cause of non-obstructive azoospermia (NOA) in males, where seminiferous tubules exclusively contain Sertoli cells, leading to minimal or absent spermatogenesis. Success rates for sperm retrieval in these cases vary significantly. We aimed to investigate the sperm retrieval rate with microdissection TESE (mTESE) in NOA patients with SCOS testicular histology and the factors that may affect it.
MATERIAL AND METHODS: Patients who underwent mTESE due to NOA were retrospectively evaluated. Only patients with a histopathological diagnosis of SCOS were included in the study. Those with other histopathological diagnoses, those who underwent conventional TESE (cTESE) were excluded from the study. The sperm retrieval rate after mTESE was calculated for patients with a pathology result of SCOS. The age, testicular volume, and Follicle-Stimulating Hormone (FSH) level of the groups with and without sperm were compared.
RESULTS: In our study, 186 patients with testicular histopathology diagnosed as SCOS were included. The rate of sperm retrieval after TESE in these patients was 28%. In patients with retrieved sperm, the mean age was 33.8 ± 5.4 years, the mean testicular volume was 11.1 ± 6.3 ml, and the mean FSH level was 22.5 ± 12.7 mIU/ml. In patients without retrieved sperm, the mean age was 33.8 ± 6.1 years, the mean testicular volume was 10.3 ± 6.1 ml, and the mean FSH level was 21.0 ± 9.8 mIU/ml. There was no significant difference observed in mean age, testicular volume, and FSH level between the group with retrieved sperm and the group without retrieved sperm (p=0.97, p=0.24, p=0.38, respectively).
CONCLUSION:
The findings of our study can be used for counseling men with NOA. Obtaining intratesticular sperm is possible in the presence of NOA and a diagnosis of SCOS histology. Therefore, patients undergoing testicular biopsy with TESE for histological examination can simultaneously prepare for intracytoplasmic sperm injection if sperm is found.

Keywords

Sertoli cell-only syndrome, non-obstructive azoospermia, infertility, testicular sperm extraction

Project Number

KA24/70

TESTİS HİSTOLOJİSİ SERTOLİ CELL-ONLY SENDROMU OLAN NON-OBSTRÜKTİF AZOSPERMİ HASTALARINDA TESTİKÜLER SPERM EKSTRAKSİYONU

Abstract

GİRİŞ: Testis biyopsisi sonucunda histopatolojik olarak Sertoli Cell Only Sendromu (SCOS) tanısı konan infertil erkeklerde Mikroskopik Testiküler Sperm Ekstraksiyonu (m-TESE) sonucunda sperm bulma başarısının incelenmesi planlandı.
MATERYAL ve METOT: Kliniğimizde Non-Obstrüktif Azospermi (NOA) nedeniyle m-TESE yapılan hastalar retrospektif olarak değerlendirildi. Çalışmaya sadece histopatoloji sonucu SCOS olan hastalar dahil edildi. Diğer histopatolojik tanılara sahip olan hastalar çalışma dışı bırakıldı. Patoloji sonucu SCOS olan hastaların m-TESE sonrası sperm bulma oranı hesaplandı. Sperm bulunan ve bulunmayan grubun yaş, testis hacmi ve Folikül Stimülan Hormon (FSH) düzeyi karşılaştırıldı.
BULGULAR: Çalışmamıza testis histolojisi SCOS olan 186 hasta dahil edildi. Bu hastaların TESE sonrası sperm bulunma oranı %28 idi. Sperm bulunan hastalarda ortalama yaş 33,8±5,4, ortalama testis hacmi 11.1± 6.3, ortalama FSH düzeyi 22,5± 12,7 mIU/ml idi. Sperm bulunmayan hastalarda ise ortalama yaş 33.8±6.1, ortalama testis hacmi 10,3± 6,1, ortalama FSH düzeyi 21,0± 9.8 mIU/ml idi. Sperm bulunan ve bulunmayan grubun ortalama yaş, testis hacmi ve FSH düzeyi arasında anlamlı farklılık saptanmadı (sırasıyla p=0,97, p=0,24, p=0,38).
SONUÇ: Testis histopatolojisi SCOS olan hastalarda TESE sonrası sperm bulma oranları genel olarak NOA hastalarında daha düşük olsa da, sperm bulma ihtimali göz önünde bulundurularak hastalar bilgilendirilmeli ve invitro fertilizasyon için hazırlık yapılmalıldır.

Keywords

Sertoli Cell Only Sendromu, Testiküler Sperm Ekstraksiyonu, Non-Obstrüktif Azospermi, İnfertilite

Project Number

KA24/70

References

• 1. Chiba K, Enatsu N, Fujisawa M. Management of non-obstructive azoospermia. Reproductive medicine and biology. 2016;15:165-173.
• 2. Kumar R. Medical management of non-obstructive azoospermia. Clinics. 2013;68:75-79.
• 3. Sasagawa I, Yazawa H, Suzuki Y, et al. Reevaluation of testicular biopsies of males with nonobstructive azoospermia in assisted reproductive technology. Archives of andrology. 2001;46(1):79-83.
• 4. Gul U, Turunc T, Haydardedeoglu B, Yaycioglu O, Kuzgunbay B, Ozkardes H. Sperm retrieval and live birth rates in presumed Sertoli‐cell‐only syndrome in testis biopsy: a single centre experience. Andrology. 2013;1(1):47-51.
• 5. Modarresi T, Hosseinifar H, Hampa AD, et al. Predictive factors of successful microdissection testicular sperm extraction in patients with presumed sertoli cell-only syndrome. International journal of fertility & sterility. 2015;9(1):107.
• 6. Taitson PF, Mourthé Filho A, Radaelli MRM. Testicular sperm extraction in men with sertoli cell-only testicular histology-1680 cases. JBRA Assisted Reproduction. 2019;23(3):246.
• 7. Pavan-Jukic D, Stubljar D, Jukic T, Starc A. Predictive factors for sperm retrieval from males with azoospermia who are eligible for testicular sperm extraction (TESE). Systems biology in reproductive medicine. 2020;66(1):70-75.
• 8. Tsujimura A. Microdissection testicular sperm extraction: prediction, outcome, and complications. International journal of urology. 2007;14(10):883-889.
• 9. Güneri Ç, Alkibay T, Tunç L. Effects of clinical, laboratuary and pathological features on successful sperm retrieval in non-obstructive azoospermia. Turkish Journal of Urology. 2016;42(3):168.
• 10. Okada H, Goda K, Yamamoto Y, et al. Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter’s syndrome. Fertility and sterility. 2005;84(6):1662-1664.
• 11. Turunc T, Gul U, Haydardedeoglu B, et al. Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study. Fertility and sterility. 2010;94(6):2157-2160.
• 12. Tournaye H, Verheyen G, Nagy P, et al. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Human reproduction (Oxford, England). 1997;12(1):80-86.
• 13. Ezeh U, Taub N, Moore H, Cooke I. Establishment of predictive variables associated with testicular sperm retrieval in men with non-obstructive azoospermia. Human reproduction. 1999;14(4):1005-1012.
• 14. Berookhim BM, Palermo GD, Zaninovic N, Rosenwaks Z, Schlegel PN. Microdissection testicular sperm extraction in men with Sertoli cell–only testicular histology. Fertility and sterility. 2014;102(5):1282-1286.
• 15. Bryson CF, Ramasamy R, Sheehan M, Palermo GD, Rosenwaks Z, Schlegel PN. Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction. The Journal of urology. 2014;191(1):175-178.
• 16. Ishikawa T. Surgical recovery of sperm in non-obstructive azoospermia. Asian journal of andrology. 2012;14(1):109.
• 17. Jezek D, Knuth U, Schulze W. Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men. Human reproduction (Oxford, England). 1998;13(5):1230-1234.
• 18. Silber SJ, Van Steirteghem A, Nagy Z, Liu J, Tournaye H, Devroey P. Normal pregnancies resulting from testicular sperm extraction and intracytoplasmic sperm injection for azoospermia due to maturation arrest. Fertility and Sterility. 1996;66(1):110-117.
• 19. Li H, Chen L-P, Yang J, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian journal of andrology. 2018;20(1):30.