非阻塞型無精症病人的取精預測因子

徐偉巽^1、2、陳一中¹、陳建志^1、2、3

馬偕紀念醫院泌尿科¹；馬偕醫學院²；馬偕醫護管理專科學校³

Predictive factors for sperm retrieval rate from male with non-obstructive azoospermia

Wei-Hsun Hsu¹² ,Yi-Zhong Chen¹, Marcelo Chen¹²³

Department of Urology, MacKay Memorial Hospital¹,
MacKay Medical College²,

MacKay Junior College of Medicine, Nursing, and Management³

Purpose:

Testicular sperm retrieval combined with intracytoplasmic sperm injection is the option for patients with non-obstructive azoospermia (NOA) to achieve fertility. Conventional testicular sperm extraction (cTESE) and microdissection testicular sperm extraction (micro-TESE) are techniques used to retrieve sperm in men with NOA. This study was conducted to investigate the predictive factors for cTESE and micro-TESE in NOA patients.

Materials and methods:

From January 2010 to December 2020, 119 patients underwent cTESE and micro-TESE were retrospectively analysed at the Urology department of the MacKay Memorial Hospital. The following parameters were recorded for each patient: medical history, physical examination, hormone profile, testicular volume, genetic variables and diagnostic testicular biopsy. We excluded patients with oligospermia, history of surgery via scrotum or inguinal area, history of vasectomy, congenital absence of the vas deferens, retrograde ejaculation or incomplete data analysis. This study included 57 consecutive NOA patients undergoing TESE and  micro-TESE at our institution.

Results:

Of the 57 men included in this series, 40.4%, 29.8%, 5.3%, 24.6% were diagnosed with presence of spermatosis, hypospermatogenesis, maturation arrest and Sertoli cell only restrictively by histopathological examination. Spermatozoa were retrieved successfully in 64.9% of total 57 patients with non-obstructive azoospermia. Sperm retrieval rate was 91.3% in normal spermatogenesis, 82.3% in hypospermatogenesis, 33.3% in maturation arrest and 7.1% in sertoli-cell only. Higher testicular volume, lower levels of FSH, LH, Prolactin, non-smoking and better histological features were predictive for sperm retrieval. We also found that to increase 1 mIU/mL level of FSH and LH, the successful sperm retrieval rate decreased 0.88 times and 0.85 times respectively. In a direct comparison, smokers were 0.29 times more likely to result in successful sperm retrieval as compared with non-smokers.

Conclusions:

Some parameters may be able to predict the chance of spermatozoa retrieval in NOA patients, including FSH, LH and Prolactin levels, testicular volume, smoke history and  histological features. In addition, the presence of sertoli-cell only confers a poor progress for sperm retrieval rate.