Analysis of factors affecting the success rate of microsperm extraction in patients with idiopathic non-obstructive azoospermia
Objective This study aims to investigate the determinants influencing the efficacy of microsurgical sperm retrieval in individuals diagnosed with idiopathic non-obstructive azoospermia(iNOA).Methods A retrospective analysis was performed on the clinical data of 757 patients diagnosed with iNOA who underwent microsurgical sperm extraction at Peking University Third Hospital between January 2019 and December 2021.The median age of patients was 31(29,33)years,and the duration of infertility was 3(2,5)years.A total of 169 patients(22.3％)received preoperative pharmacological treatment with agents such as follicle-stimulating hormone,human chorionic gonadotropin,or aromatase inhibitors.Additionally,327 patients(43.2％)underwent testicular biopsy(TESA)prior to surgery.Among these,51 cases(15.9％)exhibited sperm presence on smear microscopy,while 57 cases(17.8％)demonstrated sperm presence on pathological examination.The pathological classifications of the biopsies included 102 cases(31.9％)of reduced spermatogenic function,66 cases(20.6％)of delayed sperm maturation,and 63 cases(19.7％)of sertoli cell-only syndrome.Preoperative median pituitary prolactin(PRL)was 9.1(6.5,12.5)ng/ml,follicle-stimulating hormone(FSH)20.1(14.2,28.5)U/L,luteinizing hormone(LH)7.9(5.5,11.3)U/L,testosterone(T)117.0(81.3,154.0)nmol/L,estradiol(E2)8.7(6.3,11.8)pmol/L.Under general anesthesia,patients underwent microsurgical testicular incision for sperm retrieval.The surgical testicular volume was measured at a median of 6(5,10)ml.Among the cases studied,59 patients(7.7％)underwent left testicular surgery,213 patients(28.1％)underwent right testicular surgery,and 485 patients(64.0％)underwent bilateral testicular surgery.Furthermore,44 patients(5.8％)underwent a second microsurgical sperm retrieval procedure,while 4 patients(0.5％)underwent a third procedure.Based on the presence of sperm identified during the surgical procedure,participants were categorized into a sperm retrieval group and a non-sperm retrieval group.Clinical data of these two groups were analyzed.A subgroup analysis was performed on the observed indicators.Both univariate and multivariate logistic regression analyses were employed to examine the factors influencing the micro sperm retrieval rate.Results Among the 757 iNOA patients,255(33.7％)obtained sperm through micro sperm retrieval,while 502(66.3％)did not obtain sperm through micro sperm retrieval.The age of sperm-receiving group was higher than that of the non-sperm-receiving group[32(30,35)years vs.30(28,33)years,P＜0.01],and the course of infertility was longer than that of the non-sperm-receiving group[3.0(2.0,5.5)years vs.3.0(2.0,4.0)years,P=0.004].There was no significant difference in the sperm acquisition rate in the subgroup with or without preoperative drug treatment[38.5％(65/169)vs.32.7％(185/566),P=0.164].There was statistical significance in the sperm collection rate of different TESA results in subgroups[85.7％(24/28)of sperm were detected by microscopic smear and pathological examination and 75.9％(22/29)of sperm were detected by pathological examination and no sperm were detected by microscopic smear and 17％of sperm were not detected by microscopic smear and pathological examination(42/247),P＜0.01).The rate of spermatogenesis in the subgroup with low spermatogenic function was significantly higher than that in the subgroup with spermatogenic maturation retardation and sercell-only syndrome[47.1％(48/112),12.1％(8/66)vs.11.1％(7/63),P＜0.01].There was no significant difference in testicular volume between the seminal and non-seminal groups[6.0(5.0,10.0)ml vs.6.0(5.0,9.5)ml,P=0.862].Pituitary prolactin[8.3(5.8,12.0)ng/ml vs.9.3(7.5,13.0)ng/ml,P=0.001]and FSH[18.3(11.8,27.4)U/L vs.20.7(15.2,28.7)U/L,P=0.005]in spermated group were lower than those in non-spermated group.Luteinizing hormone[7.6(5.1,11.0)U/L vs.8.0(5.6,11.5)U/L,P=0.126],testosterone[8.8(6.0,11.8)nmol/L vs.8.7(6.4,11.7)nmol/L,P=0.607],estradiol[124.0(87.8,156.0)nmol/L vs.114.5(79.9,151.3)nmol/L,P=0.105]had no significant difference.The recovery rate of the first operation was higher than that of the second operation[97.7％(43/44)vs.81.8％(36/42),P=0.032].The sperm retrieval rate of bilateral operation was significantly lower than that of unilateral operation[6.0％bilateral(29/485)vs.86.4％left(51/59)vs.82.2％right(175/213),P＜0.01].The proportion of no sperm on one side of bilateral operation and only 4.7％(23/485)on the opposite side were obtained.The results of multivariate analysis showed that＞30 and ≤40 years old subgroup(OR=2.226,95％CI 1.364-3.632,P=0.001),＞40 and ≤50 years old subgroup(OR=4.282,95％CI 1.457-12.588,P=0.008)was higher than that of＞20 and ≤30 years old subgroup.The sperm acquisition rate of the sperm subgroup was significantly increased by smear microscopy and pathological examination(OR=6.486,95％Cl 1.444-29.127,P=0.015),while the sperm acquisition rate of the sperm subgroup was not significantly decreased by smear microscopy and pathological examination(OR=0.420,95％Cl 0.200-0.881,P=0.022).The pathological type of puncture was associated with lower spermatogenesis maturation block(OR=0.099,95％CI 0.019-0.509,P=0.006).Higher FSH(＞7.6 U/L)was associated with lower sperm yield(OR=0.324,95％CI 0.122-0.856,P=0.023).Conclusions Age,FSH level,results of testicular biopsy and pathologic type of biopsy are independent factors affecting the sperm retrieval rate of iNOA patients undergoing micro-TESE.The success rate of sperm retrieval diminished following multiple surgical procedures.Furthermore,for patients who did not have sperm successfully retrieved from one side,that the likelihood of sperm retrieval from contralateral surgery would also be low.
NETL
NSTL
万方数据
