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Category: Volume 06 Issue 06 June 2018
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Title: Prospective Study of Predictive Factors and Outcome in Sperm Retrieval of Azoospermic Males: Initial Experience in Tertiary Care Centre

Authors: Dr Deepak Kumar, Dr Namita Gupta

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.23

Abstract

Parenthood is one of the most universally desired goals in adulthood. After varicocele, azoospermia is the second major cause of infertility in men. Sperm retrieval in combination with IVF/ICSI is the only medical procedure for an azoospermic man to father a child. Various techniques have been described for sperm retrieval through testicles in azoospermic males. They include open surgery methods like open testicular biopsy (open TESE), MESA (Microscopic epididymal sperm aspiration), micro-TESE (Microscopic Testicular sperm extraction) and percutaneous methods like TESE (Testicular sperm extraction), PESA (Percutaneous epididymal sperm aspiration), TEFNA (Testicular fine needle aspiration).

Methods: This study was designed as a hospital based descriptive prospective study with the aim to find clinical, biochemical and intraoperative predictive factors for successful sperm retrieval and their predictive values amongst successful sperm retrieval.

Results: In our study of 80 azoospermic males 9 (11.25 %) were diagnosed as obstructive azoospermia & 71(88.75 %) were diagnosed as non-obstructive azoospermia patients. Difference in BMI is not statistically significant between these groups.The mean FSH, LH, Testosterone and Prolactin in non-obstructive and obstructive azoospermia patients with positive sperm retrieval was significant. Out of 71 patients with non-obstructive azoospermia TESE was successful in retrieving sperms in 28 patients (39.4%). Out of 43 unsuccessful TESE patients micro TESE was done in 34 patients and sperms could be found in 8 patients (23.5%).

Conclusion: Age, BMI among successful and unsuccessful sperm retrieval groups are comparable and don’t show any statistically significant difference. Whereas FSH, LH, Prolactin levels and mean testis volume show statistically significant difference between successful and unsuccessful sperm retrieval patients. Sperm retrieval for obstructive azoospermia gives excellent result with PESA. For non-obstructive azoospermia patients sperm retrieval can be achieved in around 50% of cases. Micro TESE increases overall sperm retrieval rates by around 12% when done after failed TESE. Microscopic seminiferous tubule appearance can be used to predict chance of sperm retrieval but requires validation by further studies and clinical pregnancy rates of around 50% can be achieved by using surgically retrieved sperms.

Keywords: obstructive and non obstructive azoospermia, Sperm retrieval technique, IVF-ICSI (Invitro fertilization- intracytoplasmic sperm injection).

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Corresponding Author

Dr Namita Gupta

Associate consultant (Obstetrics and Gynaecologist)

Ruby Hall Clinic (Wanowarie), Pune, India