Letrozole before TESE in Non-Obstructive Azoospermia, Does It Affect Sperm Retrieval Rate, A Retrospective Study (original) (raw)
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Clinical and experimental reproductive medicine, 2017
Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval. We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome. The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (p<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; p<0.01). A...
Human Reproduction, 1999
Although testicular biopsy for sperm extraction is a procedure with a potential for complications, sperm retrieval is successful in 30-70% of patients with non-obstructive azoospermia. In order to predict the probability of retrieving at least one testicular spermatozoon we conducted a prospective study of a set of variables in 40 patients with non-obstructive azoospermia. Using the receiver operating characteristic curves, we determined the probability estimates of testicular volume, plasma follicle stimulating hormone (FSH) concentration, Johnsen score and visualization of testicular spermatids in discriminating between patients with successful and failed testicular sperm extraction. Visualization of testicular spermatids provided the best estimate of success of testicular sperm extraction. Of the factors studied using logistic-regression analysis (age, maternal and paternal age at birth, body mass index, luteinizing hormone, testosterone, FSH, testicular volume, the presence of testicular spermatids and Johnsen score), only the presence of spermatids and Johnsen score were independent variables able to predict the success of testicular sperm extraction. The visualization of the presence of spermatids gave a correct prediction of 77% and Johnsen score of 71%. The diagnostic model derived from these independent predictors when validated in 40 patients using the Jackknife technique gave a correct overall prediction of 87%. The probability of successful testicular sperm extraction in patients with non-obstructive azoospermia could be objectively predicted on the basis of simple histopathological criteria represented by the visualization of testicular spermatids and Johnsen score.
Fertility and Sterility, 2021
Objective: To explore predictors of successful sperm retrieval (SR) and to identify potentially suitable candidates for testicular sperm aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. Design: Retrospective chart review. Setting: Academic tertiary medical center. Patients: A total of 297 patients with nonobstructive azoospermia. Interventions: All patients underwent full clinical evaluation before undergoing a staged SR procedure, starting with TESA and proceeding to microsurgical testicular sperm extraction (microTESE). Predictors of positive SR with TESA were selected using the least absolute shrinkage and selection operator (LASSO) regression analysis using k-fold cross-validation. The obtained regression coefficients were used to create a predictive model, and a receiver operating characteristic (ROC) curve was obtained to express its predictive ability. Cutoff values for each significant predictor were also identified using ROC analysis. Main outcome measure(s): Development of a prediction model for positive SR with TESA. Results: Overall, a positive SR was observed in 23.6% of patients undergoing TESA. Average testis size (P ¼ .017) and serum folliclestimulating hormone (FSH) level (P < .001) were the significant predictors of positive SR identified by LASSO regression analysis. The predictive model had an AUC of 0.742 with a sensitivity of 73.9% and specificity of 69.9%. Patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L had a TESA-positive SR of 43%. Conclusions: TESA may be a suitable alternative to microTESE in selected nonobstructive azoospermia patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L.
Objectives: This study aimed to determine the role of pre-surgical markers in the prediction of sperm retrieval in infertile Vietnamese men with azoospermia. Patients and Methods:Retrospective descriptive analysis of 136 infertile men with azoospermia, examined from August 2014 to July 2018. Patients underwent stepwise surgical sperm retrieval via percutaneous epididymal sperm aspiration, testicular sperm aspiration then multiple testicular sperm extraction in up to 3 locations until sperm were detected. Factorswere analyzed to determine the prediction of sperm retrieval.Results: The overall success rate of sperm retrieval was 49.3% including 88.3% and 18.4% in the OA and NOA group, respectively. The results of sperm retrieval were significantly associated only with the OA and NOA group, not with endocrine test or testicular volume. We found no significant difference in the endocrine test and testicular volume’s result between successful and unsuccessful sperm retrieval in either gr...
Journal of assisted reproduction and genetics, 2016
The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE). We retrospectively evaluated 356 patients with non-obstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve. The mean patients' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest...
Prediction of successful sperm retrieval in patients with nonobstructive azoospermia
Urology journal, 2006
Our aim was to evaluate the predictive values of factors that indicate successful sperm retrieval in men with nonobstructive azoospermia. We evaluated 85 infertile men with nonobstructive azoospermia who underwent multiple bilateral testicular biopsies. Factors including age, infertility period, surgical history, testicular volume, testicular consistency, serum follicle-stimulating hormone (FSH), serum inhibin B, serum luteinizing hormone, and serum total testosterone were assessed in relation to sperm retrieval results. Spermatozoa were retrieved in 18 biopsies (21.2%). Follicle-stimulating hormone, serum inhibin B, and testicular volume were associated with the results of sperm retrieval. Men with a higher testicular volume, a higher serum inhibin B, and a lower FSH had successful sperm retrieval. The cutoff points were determined as 9.5 mL for testicular volume, 9.9 IU/L for serum FSH, and 39.8 pg/mL for serum inhibin B. These 3 factors had strong correlations with each other. Th...
Non obstructive azoospermia (NOA), due to testicular failure, revealed up to 60% of all cases of azoospermia. One of the decisive NOA management is performing testicular sperm extraction (TESE) with success rates approximately 50%, yet a factor for predicting TESE quality is still insufficient. The objective of this work was to assess and develop an alternative outcome predictor of TESE procedure in NOA. To this purpose, a retrospective case series was performed to 31 patients with azoospermia undergone TESE in 2016-2018. Collected data included a clinical history, testicular volume, hormone levels and testicular histology were analyzed following sperm retrieval. The findings resulted in 14 patients had obstructive azoospermia (OA) and 17 patients had NOA. The results showed that all of OA patients had positive sperm retrieval, while NOA patients were 50%. The analyzed data performed that the normal value of testicular size, FSH and the high Johnson score (8) were the finest predictor of positive sperm retrieval. In conclusion, the modification of Johnson score may be utilized as a promising predictor of successful or positive surgical sperm retrieval in NOA.
Systems Biology in Reproductive Medicine, 2019
The aim of this study was to evaluate the predictive value of factors in infertile male patients to retrieve sperm from their testicles before they undergo testicular sperm extraction (TESE). In total, 64 males were enrolled in this study. Infertility was identified as obstructive azoospermia (OA); non-obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). Age, body mass index and concomitant conditions were noted. Testicular volumes, serum levels of Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), testosterone (T) and prolactin were investigated. Sperm retrieval after TESE was noted as positive or negative. Average age of the cases was 36.8 years. TESE success rate of testicular sperm retrieval rate was 50.0%. Majority of men (83.9%) had a 46, XY karyotype, minority had genetic anomalies, and 5 of were diagnosed with KSall were TESE-negative. There was no statistical difference in age, testicular volume, presence of varicocele and microcalcifications or hormonal levels in the TESE-positive and negative groups. Smoking as an independent variable was the only risk factor statistically showing (OR = 0.269; p = 0.045) prediction of negative sperm retrieval after the TESE procedure. None of the parameters investigated herein predicted successful TESE outcomes. However, in cases with negative TESE only smoking was identified as a predictive factor for negative sperm retrieval and was established as a risk factor.
Medical Archives
Introduction: Main categorisation of azospermic is in two grups: nonobstructive azoospermia (NOA) and obstructive azoospermia (OA). We had evaluation of prognostic factors and determinants in sperm retrieval procedures in azoospermic patients. Methods: Retrospective evaluation observed 21 selected patients with NOA and OA azoospermia, after that complete history, physical examination with ultarsound volume of testis and hormonal profile. Hormonal profile included: follicle stimulating hormone (FSH), luteinizing hormone (LH), testosteron (T) and prolactin (P) serum levels. Also karyotype and Y-deletion analysis were done and analyzed. Results: 9 OA patients (42,9%) were undergone for TESE operation and 12 NOA patients (57,1%) for Micro-TESE operation. All TESE procedures were positive (100%). Micro-TESE in 12 selected NOA patients, 5 patients (41,6%) were positive and 7 patients (58,4%) negative. Patients testicular size, serum FSH and testosterone level showed correlation in success of sperm retrieval procedures. Conclusion: TESE is elected procedure for obstructive azospermia (OA). Micro-TESE is appropriate sperm retrieval procedurec for patients with non-obstructive azoospermia (NOA) and correlate with high FSH and small volume of testis.
The Journal of Urology, 2012
Purpose: Although optimizing endogenous testosterone production before testicular sperm extraction is commonly practiced, whether improved preoperative testosterone levels enhance sperm retrieval remains unclear. We evaluated the influence of preoperative medical therapy in men with nonobstructive azoospermia before microdissection testicular sperm extraction. Materials and Methods: A total of 1,054 men underwent microdissection testicular sperm extraction from 1999 to 2010. Patients with preoperative testosterone levels less than 300 ng/dl were treated with aromatase inhibitors, clomiphene citrate or human chorionic gonadotropin before microdissection testicular sperm extraction with the goal of optimizing testosterone levels. Patient demographics, preoperative testosterone levels, sperm retrieval rate and pregnancy outcomes were recorded and compared in men with different baseline testosterone levels. Results: Of the 736 men who had preoperative hormonal data 388 (53%) had baseline testosterone levels greater than 300 ng/dl. The sperm retrieval rate in these men was 56%. In the remaining 348 men with pretreatment testosterone levels less than 300 ng/dl, the sperm retrieval rate was similar (52%, p ϭ 0.29). In addition, the sperm retrieval, clinical pregnancy and live birth rates were similar between men who responded to hormonal therapy and those who did not. Conclusions: Men with nonobstructive azoospermia and hypogonadism often respond to hormonal therapy with an increase in testosterone levels, but neither baseline testosterone level nor response to hormonal therapy appears to affect overall sperm retrieval, clinical pregnancy or live birth rates.