Surgical sperm retrieval in Non-Obstructive Azoospermia(NOA) - How do we predict success?
Ponnusamy, AK1; Vasan, SS1; Manoharan, M1
Introduction: Surgical methods of sperm retrieval have created more opportunities for enhancing fertility in patients with non-obstructive azoospermia (NOA). However, these techniques are not only invasive, but many a times, give disappointing results in terms of sperm retrieval. Normal FSH does not conclude spermatogenesis and high FSH does not rule out spermatogensis. Non-invasive markers like epididymal head size and Inhibin B may be helpful in the prediction of sperm retrieval. Testicular sperm retrieval techniques associated with intracytoplasmic sperm injection have changed the field of male infertility treatment and given many azoospermic men the chance to become biological fathers. Despite the current use of testicular sperm extraction, reliable clinical and laboratory prognostic factors of sperm recovery are still absent.
Objective: The aim is to improve the prediction of sperm retrieval by using non-invasive markers in men with non-obstructive azoospermia. This helps to predict who will benefit from Microsurgical Testicular Sperm Extraction.
Materials and Methods: This is a retrospective study including 60 consecutive patients diagnosed with non-obstructive azoospermia who underwent Microsurgical Testicular Sperm Extraction from January 2015 to May 2016 .Serum FSH, Inhibin B, testicular volume and epididymal head size were measured. Only those cases were included where the epididymal tubules were noted to be undilated intraoperatively. Correlation of these markers was done in terms of successful sperm retrieval.
Results: Out of 60 patients 41 had normal FSH. Of these 27 (65.85 %) patients had sperms during MicroTESE. Among 19 patients with FSH>12.5mIU/ml, 8 (42.1 %), had sperms. Twenty four patients had Inhibin B < 40 pg/ml, 14 had between 41 – 80 pg/ml and 22 had >80 pg/ml with successful sperm retrieval in 29.2%, 71.4% and 82% respectively. Thirty six patients had epididymal head size > 7mm and sperm retrieval was positive in 80.6%. It was also noted that in patients with FSH > 20 mIU/ml, the chance of not retrieving sperms was 70%. In patients with Inhibin B <10 pg/dl the chance of not retrieving sperms was 100% in our study.
Conclusion: Serum Inhibin B and epididymal head size are more reliable than serum FSH alone. Combination further increases the predictive accuracy of sperm retrieval in non-obstructive azoospermia
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