Analysis Of 130 NOA Patients With Micro-TESE And 29 Patients With ICSI Outcome

Part I Analysis of the effect of micro-dissection of testicular sperm extraction in 130 cases with non-obstructive azoospermiaObjective: To analyze the clinical efficacy of micro-dissection of testicular sperm extraction(micro-TESE)in treatment of non-obstructive azoospermia(NOA).Methods: The clinical data of 130 patients with NOA underwent micro-TESE between December 2015 and December 2017 was retrospectively analyzed.Patient data were collected,including basic data,testicular volume,preoperative hormone levels(FSH,T).56 patients underwent testicular biopsy.The effects of different types of NOA on sperm retrieval rate(SRR)were analyzed.The effects of age,testical volume,T and FSH in 130 patients with NOA on sperm retrieval were evaluated.Serum T changes were observed.SPSS 19.0 statistical software was used for data analysis and processing.Results: There were 36 cases of idiopathic NOA,22 cases of idiopathic NOA+ small testis,18 cases of Klinefelter's syndrome,46 cases of cryptorchidism and 8 cases of AZF microdeletions(c area).All micro-TESE were successfully completed.The SRR of cryptorchidism after operation group was significantly higher than those of other NOA groups(P<0.05),and there was no significant difference between other NOA groups(P>0.05).No significant difference was showed in age,testical volume,T,FSH in NOA accepted micro-TESE and retrieve sperm,respectively(P>0.05).Compared with the preoperative level,the serum testosterone(T)level decreased significantly in 1 month after operation(P<0.01),decreased significantly in 6 months after operation(P<0.01),respectively.Compared with that of 1 month after operation,the serum T level increased significantly in 6 months after operation(P<0.01).Conclusions: micro-TESE is an effective method for the treatment of NOA and may be worthy of popularization and application.The different NOA type can influence SRR.Part II Effect of testicular pathology in patients with non-obstructive azoospermia on sperm retrieval rateObjective: To analyze the effect of preoperative testicular biopsy pathology on SRR in patients with NOA.Methods: The clinical data of 56 patients with NOA underwent preoperative testicular biopsy and micro-TESE treatment between December 2015 and December 2017 was retrospectively analyzed.All patients underwent a testicular biopsy under local anesthesia,the testicular pathology was detected,then micro-TESE treatment was performed to calculate SRR.The effects of different testicular pathological changes on SRR were analyzed.Results: All micro-TESE procedures were successfully completed.Among the 56 patients with NOA,there were 8 cases(14.3%)with hypospermatogenesis,17 cases(30.4%)with SCOS,18 cases(32.1%)with SCOS+ SCOS+ hyalinization,and 13 cases(23.2%)with Spermatogenic blocking.The difference of the SRR between testicular pathology groups was statistically significant(P<0.05).Among them,the hypospermatogenesis group obtained the highest SRR(100%),the SRR of the Sertoli cell only syndromes group was lower(11.8%),and the SRR of the spermatogenic blocking group was 0.Conclusions: Preoperative testicular pathology can reflect the degree of impaired testis and affect the SRR of sperm retrieval.Part III Clinical efficacy of micro-TESE combined with ICSI in the treatment of patients with NOAObjective: To analyze the clinical efficacy of micro-TESE combined with intracytoplasmic sperm injection(ICSI)in the treatment of NOA patients.Methods: The clinical data of 56 patients with NOA acquired sperm via micro-TESE and ICSI in 29 cases between December 2015 and December 2017 was retrospectively analyzed.Ovulation was performed in 29 spouses,egg follicle monitored by ultrasound,h CG injected,egg retrieved under ultrasound guidance,ICSI performed and embryo transferred.We observed the number of eggs taken,ICSI cycles,2PN,2PN cleavage,transplantable embryos,high-quality embryos,frozen embryos-clinical pregnancy,fresh transplant-clinical pregnancy,live births and spontaneous abortions.Results: Twenty-nine patients were treated with ICSI.A total of 42 egg retrieval cycles and 32 ICSI cycles were completed.The number of 2PN was 5.5,2PN cleavage 5.2,transplantable embryos 5,high-quality embryos 2.9.Frozen embryos-clinical pregnancy was 14,fresh transplant-clinical pregnancy 3,including 6 live births and 6 spontaneous abortion.Conclusions: Micro-TESE combined with ICSI in the treatment of NOA is effective and feasible and may make NOA patients get the offsprings with their own genetics.