Microscopic testicular sperm extraction (micro-TESE) for azoospermia at a large tertiary referral centre: Male and female factors and outcomes

Abstract

Objectives:

To report on the outcomes and demographics of azoospermic couples undergoing microscopic testicular sperm extraction (micro-TESE) in a large tertiary referral centre.

Subjects and methods:

A retrospective study of patients undergoing micro-TESE in a tertiary referral centre from March 2015 to August 2019 was undertaken. Histopathology, patient demographics, comorbidities, patient factors and live birth outcomes were evaluated.

Results:

A total of 102 micro-TESEs were performed with a sperm retrieval rate (SRR) of 30.3%. The successful group had a mean age of 32.7 years and a mean body mass index (BMI) of 26.8 kg/m². Female partners in the successful group had a mean age of 32.2 years. Twenty percent of female partners had infertility factors, 86.7% had no previous pregnancy and 13.3% had a previous miscarriage. The successful group had 15 live births (50%), while 20% had frozen their sperm. 93.3% achieved live birth from single embryo transfer and currently have unutilised embryos in cryostorage to possibly create siblings in the future. Twenty percent had more than one live birth from a single micro-TESE. Sertoli cell-only syndrome (SCOS) was identified in 57.5% of all cases. This was bilateral in 80% of these cases (four cases only sampled unilaterally due to previous orchidectomies). Of the SCOS group, six men went on to have successful sperm extraction (10%). The presence of previous urologic history/surgery increased the risk of azoospermia by 13%.

Conclusion:

Men with previous urological conditions have an increased risk of azoospermia. SCOS was identified in 57.5% of cases making it the most common histopathological diagnosis in azoospermic men. Based on our cohort, micro-TESE offers potential sperm retrieval in azoospermic men with SCOS. Successful sperm extraction in patients was associated with 50% live births and appeared to be unaffected by the presence of male/female factors. The number of live births could be higher as 20% had frozen their sperm. Concurrent female issues did not appear to affect successful outcome after micro-TESE, although numbers are small.

Level of evidence:

Not applicable

Keywords

Micro-TESE azoospermia male infertility

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