The Outcome Of Microdissection Testicular Sperm Extraction And Assisted Reproductive Treatment With Non-obstructive Azoospermia

Objective:To evaluate retrospectively the sperm retrieval rate of microdissection testicular sperm extraction(MD-TESE)in men with non-obstructive azoospermia(NOA)and to identify the factors that influencing successful sperm retrieval.The outcome of assisted reproductive treatment with sperm retrieved from MD-TESE was analyzed such as fertilisation rate,quality embryo rate,transplantable embryo rate,clinical pregnancy rate,aim to provide theoretical basis for medical choice.Methods:Retrospectively analysis the 160 cases of MD-TESE with non-obstructive spermatozoa which were conducted in the first hospital of jilin university from March 2016 to June 2018.According to successful or not of sperm retrieval,they were divided into the successful group(48 cases)and the failure group(112 cases).Factors including age,testicular volume and reproductive hormone levels were compared between the two groups.According to different testis volume,the pathological classification of the testicular tissue,and directly MD-TESE or not,the sperm retrieval rate was calculated respectively.After exclude women's factors,55 cycles of intracytoplasmic sperm injection(ICSI)performed with sperm from MD-TESE were taken as research group,and 12 cycles of ICSI by conventional testicular sperm extraction with non-obstructive azoospermia were taken as control group One,76 cycles of ICSI by conventional testicular sperm extraction with obstructive azoospermia were taken as control group Two.In addition,the research group was divided into two subgroups: fresh sperm and freeze-thawed sperm.For the above groups,the fertilization rate,embryo cleavage rate,high quality embryo rate,transplantable embryo rate were calculated,and clinical pregnancy rate,implanting rate,abortion rate.Results:1.Among the 160 MD-TESE patients,48 cases had obtained Sperm,and the overall sperm retrieval rate(SRR)was 30.00%.2.The mean volume of testicles in the sperm retrieval successful group was smaller than that in the failure group(5.00vs6.00,P=0.043),which was statistically significant.There was no significant difference in men's age as well as the levels of follicle stimulating hormone,testosterone/luteinizing hormone ratio,estradiol,prolactin,and inhibin B,respectively:31.69vs30.60,23.79vs24.50,26.35vs26.71,281.07vs262.09,2.17vs1.35,26.16vs22.56?3.According to the testicular volume,in totle 160 cases were divided into three groups.The SRR was 35.58%(37/104)in less than 8ml group.The SRR was 16.33%(8/49)in the 8-12 ml group and 42.86%(3/7)in >12ml group.The difference between the first two groups was statistically significant(P=0.025),while the smaller testis group got higher SRR.4.Sertolicell-only syndrome accounted for the most of the three pathological types,with 75.42%(89/118)incidence rate but the lowest SRR of 14.61%(13/89).The SRR of maturationarrest was 25.00%(3/12)and hypospermatogenesis was 88.24%(15/17).Different types of testicular tissue pathology showed different sperm retrieval rates,with the highest of hypospermatogenesis and the lowest of sertolicell-only syndrome,which difference was statistically significant,P<0.001.5.The SRR of the remedial MD-TESE is 26.09%(6/23),close to the direct MD-TESE(30.66%,42/137),which difference was not statistically significant,P=0.658.6.There was no significant difference between MD-TESE and control group One: fertilization rate(65.19%vs66.07%,P=0.856),quality embryo rate(43.92%vs 36.92%,P=0.293),transplantable embryo rate(61.64%vs56.92%,P=0.471),clinical pregnancy rate(50.82%vs38.62%,P=0.418),embryo implanting rate(34.78%vs29.63%,P=0.610),and live birth rate(77.27%vs87.50%,P=1.000).Compared with control group Two,the fertilization rate of MD-TESE group was significantly lower(65.19% vs 78.66%,P<0.001),and there was no significant difference in the quality embryo rate(43.92%vs47.73%,P=0.238),transplantable embryo rate(61.64%vs59.94%,P=0.591),clinical pregnancy rate(50.82%vs52.22%,P=0.866),embryo implantation rate(34.78%vs37.21%,P=0.675),and live birth rate(77.27%vs85.42%,P=0.619).No birth defects were found in all babies born.7.Comparison of ICSI with fresh sperm(33 cases)and freeze-thawed sperm(22 cases): the fertilization rate of the former was significantly higher than that of the latter(72.86% vs 56.10%,P<0.001).There was no significant difference in quality embryo rate(45.60%vs40.63%,P=0.356),transplantable embryo rate(64.80%vs55.47%,P=0.077),clinical pregnancy rate(51.22%vs50.00%,P=0.929),embryo implantation rate(37.6%vs28.95%,P=0.356).Conclusion:1.The MD-TESE can find the sperms that cannot be found by conventional surgery through the microscopic examination of the seminiferous tubules.It can be applied to NOA patients with spermatogenesis disorder,which brings them more opportunity to have blood relatives.2.In patients with small testicular volume,the likelihood of sperm retrieval is not low,or even higher.The histopathological classification of testis can provide reference value for the prediction of SRR before operation.Age,FSH and other hormone levels of the patient were not found to be related to sperm retrieval.3.The sperm from MD-TESE does not affect the embryonic development,and a satisfactory pregnancy outcome can be achieved.4.The ability to fertilize the oocytes by freeze-thawed sperm is lower than that of fresh sperm,but early embryo development and pregnancy outcomes are both well.MD-TESE combined with freezing technology of rare sperm can effectively improve the utilization rate of sperm,increase the number of transplantable embryos through multiple ovulation cycles when needed,so as to improve the probability of pregnancy and successful reproduction of patients.