Keywords
non-obstructive azoospermia
testicular sperm extraction
How to Cite
Abstract
Testicular sperm extraction (TESE) allows for the possibility of intracytoplasmic sperm injection (ICSI) to achieve fertility but is an invasive procedure, and failed testicular sperm extraction has brought significant emotional and financial consequences to couples.
Objective: This study aims to determine the relationship of pre-operative work-up variables such as age, FSH, LH, total testosterone in the success or failure of TESE in patients by 2 urologists with nonobstructive azoospermia in St. Luke's Medical Center-Global City.
Materials and Methods: This is a retrospective chart review of patients presenting with infertility, diagnosed to have non-obstructive azoospermia and underwent conventional TESE from 2012 to 2016 at St. Luke's Medical Center-Global City. Patients were adult males presenting with infertility undergoing conventional TESE, known to have non-obstructive azoospermia. TESE outcomes of 46 patients with complete parametric laboratory exams warranted for this study were used for statistical analysis.
Results: T-test results showed no sufficient evidence to conclude that there is significant difference in mean age (p-value = 0.509), mean LH (p-value = 0.549), mean FSH (p-value = 0.81), and total testosterone (p-value = 0.824) between patients who had successful and failed TESE. Fisher's exact test showed that most patients (90.3%) who have successful TESE outcome have normal FSH values. Logistic regression results showed no sufficient evidence to conclude that there is significant relationship between TESE outcome and age (p-value = 0.503), LH (p-value = 0.542), FSH (p-value = 0.098), and TT (p-value = 0.819). Patients with normal FSH values are 6.22 times more likely to have successful TESE outcomes compared to patients with elevated FSH values. However, logistic regression results showed no sufficient evidence to conclude that there is significant relationship between successful TESE outcome and normal LH values (OR = 2.0, p-value = 0.493).
Conclusion: The preoperative factors for predicting success and failure of sperm retrieval during TESE, including total testosterone, FSH and LH levels, were examined in this study, may not fully give an estimation of the chances of obtaining spermatozoa in patients with NOA. Accordingly, the combination and simultaneous interpretation of the other factors not present in this study, such as testicular volume, histopathological patterns, and karyotyping, would likely help to provide a more accurate prediction of success and failure and subsequently help the clinician to pursue the appropriate methods of treatment for these patients.