Nonobstruktif Azospermik Hastalarda Yapılan Mikrocerrahi Testiküler Sperm Ekstraksiyonu Sonuçları ve Bu Sonuçları Etkileyen Faktörlerin Değerlendirilmesi
Abstract
Amaç: Kliniğimizde nonobstruktif azospermi (NOA) tanısıyla mikro-TESE (mikrocerrahi testiküler sperm ekstraksiyonu) uygulanan 71 hastanın sonuçlarını, hormonal özelliklerini ve bu sonuçların Johnsen skorlarıyla ilişkisini incelemek.
Hastalar ve Yöntem: Kliniğimize 2010-2014 yılları arasında başvuran ve NOA tanısıyla mikro-TESE uygulanan 71 hastanın verilerini retrospektif olarak inceledik. Hastaların yaşı, infertilite süreleri, geçirdiği operasyonlar, ortalama testis volümleri, kan FSH (folikül stimülan hormon), LH (luteinizan hormon), total testosteron ve prolaktin düzeyleri, biyopsi alınan hastaların biyopsi sonuçları ve bunların mikro-TESE başarısı ile ilişkisi değerlendirildi.
Bulgular: Mikro-TESE uygulanan 71 hastanın 25’inde (%35,21) sperm bulunmuş, bunların 6 (%8,45) tanesinde gebelik gelişmiştir. Ortalama testis hacimleri sağ 14,3±3,80 (4-22) cc, sol 13,7±3,41 (4-20) cc olarak bulunmuştur. FSH ve LH değeri arttıkça sperm bulma olasılığı azalmıştır (p<0,05). Total testosteron ve prolaktin düzeyleri ile TESE'de sperm bulma arasında korelasyon saptanmamıştır (p>0,05).
Sonuç: Mikro-TESE’de sperm elde etme başarısı hasta yaşı, geçirilmiş testis operasyonu, testis volümü, hastanın hormonal profili ile değişebilmektedir. Sperm elde etme başarısı histoloji, kan FSH ve LH değerleri ile korele olup, hasta yaşı, infertilite süresi, kan total testosteron, prolaktin değerleri ve testis volümü ile ilişkisi net değildir
Keywords
References
- 1. Omisanjo OA, Ikuerowo SO, Abdulsalam MA, Ajenifuja SO, Shittu KA. Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors. Int J Reprod Med.. 2017;2017: 4607623.
- 2. Katz DJ, Teloken P, Shoshany O. Male infertility - The other side of the equation. Aust Fam Physician. 2017; 46(9):641-646.
- 3. Flannigan R, Bach PV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol. 2017; 6(4):745-752.
- 4. Ishikawa T. Surgical recovery of sperm in non-obstructive azoospermia. Asian J Androl. 2012; 14(1):109-115.
- 5. Hendry WF. Azoospermia and Surgery for Testicular Obstruction 2. ed. London: Springer; 1994.
- 6. Colpi GM, Piediferro G, Nerva F, Giacchetta D, Colpi EM, Piatti E. Sperm retrieval for intra-cytoplasmic sperm injection in non-obstructive azoospermia. Minerva Urol Nefrol. 2005; 57(2):99-107.
- 7. Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014; 2(1):20-24.
- 8. Humm KC, Sakkas D. Role of increased male age in IVF and egg donation: is sperm DNA fragmentation responsible? Fertil Steril. 2013; 99(1):30-36.
- 9. Althakafi SA, Mustafa OM, Seyam RM, Al-Hathal N, Kattan S. Serum testosterone levels and other determinants of sperm retrieval in microdissection testicular sperm extraction. Transl Androl Urol. 2017; 6(2):282-287.
- 10. Belloc S, Cohen-Bacrie P, Benkhalifa M, Cohen-Bacrie M, De Mouzon J, Hazout A, et al. Effect of maternal and paternal age on pregnancy and miscarriage rates after intrauterine insemination. Reprod Biomed Online. 2008; 17(3):392-397.
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- 15. George JW, Dille EA, Heckert LL. Current concepts of follicle-stimulating hormone receptor gene regulation. Biol Reprod. 2011; 84(1):7-17.
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- 18. Yildirim ME, Koc A, Kaygusuz IC, Badem H, Karatas OF, Cimentepe E, et al. The association between serum follicle-stimulating hormone levels and the success of microdissection testicular sperm extraction in patients with azoospermia. Urology J. 2014; 11(4):1825-1828.
- 19. Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl. 2013; 23:5.
- 20. Hussein A, Ozgok Y, Ross L, Rao P, Niederberger C. Optimization of spermatogenesis-regulating hormones in patients with non-obstructive azoospermia and its impact on sperm retrieval: a multicentre study. BJU Int. 2013;111(3 Pt B):E110-114.
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- 22. Reifsnyder JE, Ramasamy R, Husseini J, Schlegel PN. Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia. The Journal of urology. 2012; 188(2):532-536.
- 23. Modarresi T, Hosseinifar H, Daliri Hampa A, Chehrazi M, Hosseini J, Farrahi F, et al. Predictive factors of successful microdissection testicular sperm extraction in patients with presumed sertoli cell-only syndrome. Int J Fertil Steril. 2015; 9(1):107-112.
- 24. Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int. 2013; 111(3):492-499.
- 25. Yang QE, Oatley JM. Spermatogonial stem cell functions in physiological and pathological conditions. Curr Top Dev Biol. 2014; 107:235-267.
- 26. Silber SJ. Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod. (Oxford, England). 2000; 15(11):2278-2284.
Microsurgical Testicular Sperm Extraction Results in Nonobstructive Azospermic Disease and Evaluation of the Factors Affecting These Results
Abstract
Aim: To investigate the hormonal properties and results of 71 patients, who were diagnosed with nonobstructive azoospermia (NOA) and performed micro-TESE (microsurgical testicular sperm extraction) at our clinic, and the relationship of these results and Johnsen scores.
Patients and Method: We retrospectively reviewed the data of 71 patients who came to our clinic and were diagnosed with NOA and got performed micro-TESE between the years of 2010 and 2014. Variables such as age, the duration of infertility, operations underwent, mean testis volumes, blood FSH (follicle stimulated hormone), LH (luteinizing hormone), total testosterone and prolactin levels, results and their relations with sperm retrieval rates were examined.
Results: Sperm were found in 25 (35.21%) of 71 patients, who were performed micro-TESE, and 6 (8.45%) of them have developed pregnancy. Mean testis volumes were found 14.3 ± 3.80 (4-22) cc on the right and 13.7 ± 3,41 (4-20) cc on the left. As FSH and LH values increased, the probability of sperm retrieval rate was decreased (p <0.05). There was no correlation between total testosterone and prolactin levels with sperm retrieval in TESE (p> 0,05).
Conclusion: In micro-TESE, the success of sperm retrieval can be affected by patient age, having testis operation history, testis volume, patient's hormonal profile. Sperm retrieval success correlates with histology, blood FSH and LH values, if there is a relation sperm retrieval success and patient age, duration of infertility, blood total testosterone, prolactin levels and testis volume is unclear.
Keywords
References
- 1. Omisanjo OA, Ikuerowo SO, Abdulsalam MA, Ajenifuja SO, Shittu KA. Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors. Int J Reprod Med.. 2017;2017: 4607623.
- 2. Katz DJ, Teloken P, Shoshany O. Male infertility - The other side of the equation. Aust Fam Physician. 2017; 46(9):641-646.
- 3. Flannigan R, Bach PV, Schlegel PN. Microdissection testicular sperm extraction. Transl Androl Urol. 2017; 6(4):745-752.
- 4. Ishikawa T. Surgical recovery of sperm in non-obstructive azoospermia. Asian J Androl. 2012; 14(1):109-115.
- 5. Hendry WF. Azoospermia and Surgery for Testicular Obstruction 2. ed. London: Springer; 1994.
- 6. Colpi GM, Piediferro G, Nerva F, Giacchetta D, Colpi EM, Piatti E. Sperm retrieval for intra-cytoplasmic sperm injection in non-obstructive azoospermia. Minerva Urol Nefrol. 2005; 57(2):99-107.
- 7. Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014; 2(1):20-24.
- 8. Humm KC, Sakkas D. Role of increased male age in IVF and egg donation: is sperm DNA fragmentation responsible? Fertil Steril. 2013; 99(1):30-36.
- 9. Althakafi SA, Mustafa OM, Seyam RM, Al-Hathal N, Kattan S. Serum testosterone levels and other determinants of sperm retrieval in microdissection testicular sperm extraction. Transl Androl Urol. 2017; 6(2):282-287.
- 10. Belloc S, Cohen-Bacrie P, Benkhalifa M, Cohen-Bacrie M, De Mouzon J, Hazout A, et al. Effect of maternal and paternal age on pregnancy and miscarriage rates after intrauterine insemination. Reprod Biomed Online. 2008; 17(3):392-397.
- 11. Frattarelli JL, Miller KA, Miller BT, Elkind-Hirsch K, Scott RT, Jr.Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles. Fertil Steril. 2008; 90(1):97-103.
- 12. Ramasamy R, Padilla WO, Osterberg EC, Srivastava A, Reifsnyder JE, Niederberger C, et al. A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol. 2013; 189(2):638-642.
- 13. Mitchell V, Robin G, Boitrelle F, Massart P, Marchetti C, Marcelli F, et al. Correlation between testicular sperm extraction outcomes and clinical, endocrine and testicular histology parameters in 120 azoospermic men with normal serum FSH levels. Int J Androl. 2011; 34(4):299-305.
- 14. Tsujimura A, Matsumiya K, Miyagawa Y, Takao T, Fujita K, Koga M, et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol. 2004; 172(5 Pt 1):1944-1947.
- 15. George JW, Dille EA, Heckert LL. Current concepts of follicle-stimulating hormone receptor gene regulation. Biol Reprod. 2011; 84(1):7-17.
- 16. Zitzmann M, Nordhoff V, von Schonfeld V, Nordsiek-Mengede A, Kliesch S, Schuring AN, et al. Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue. Fertil Steril. 2006; 86(2):339-347.
- 17. Hauser R, Temple-Smith PD, Southwick GJ, de Kretser D. Fertility in cases of hypergonadotropic azoospermia. Fertil Steril. 1995; 63(3):631-636.
- 18. Yildirim ME, Koc A, Kaygusuz IC, Badem H, Karatas OF, Cimentepe E, et al. The association between serum follicle-stimulating hormone levels and the success of microdissection testicular sperm extraction in patients with azoospermia. Urology J. 2014; 11(4):1825-1828.
- 19. Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl. 2013; 23:5.
- 20. Hussein A, Ozgok Y, Ross L, Rao P, Niederberger C. Optimization of spermatogenesis-regulating hormones in patients with non-obstructive azoospermia and its impact on sperm retrieval: a multicentre study. BJU Int. 2013;111(3 Pt B):E110-114.
- 21. Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R. Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia. 2008; 40(4):219-226.
- 22. Reifsnyder JE, Ramasamy R, Husseini J, Schlegel PN. Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia. The Journal of urology. 2012; 188(2):532-536.
- 23. Modarresi T, Hosseinifar H, Daliri Hampa A, Chehrazi M, Hosseini J, Farrahi F, et al. Predictive factors of successful microdissection testicular sperm extraction in patients with presumed sertoli cell-only syndrome. Int J Fertil Steril. 2015; 9(1):107-112.
- 24. Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int. 2013; 111(3):492-499.
- 25. Yang QE, Oatley JM. Spermatogonial stem cell functions in physiological and pathological conditions. Curr Top Dev Biol. 2014; 107:235-267.
- 26. Silber SJ. Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod. (Oxford, England). 2000; 15(11):2278-2284.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 15, 2017 |
| Submission Date | October 30, 2017 |
| Acceptance Date | November 23, 2017 |
| Published in Issue | Year 2017 Volume: 1 Issue: 3 |
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