Time to first infertility diagnosis and sperm retrieval rate: results after 30 consecutive micro TESE in NOA patients
Sacca, A1; La Croce, G1; Angiolilli, D1; Pellucchi, F1; Rocchini, L1; Belussi, D1; Nicolai, M1; Castellucci, E1; Deiana, G1; Naspro, RL1; Roscigno, M1; Manica, M1; Da Pozzo, LF1
1: ASST PAPA GIOVANNI XXIII, BERGAMO, Italy
Objective: Data available in the literature are still lacking about a possible correlation between time to first infertility diagnosis, age and sperm retrieval rate. In this prospective study we reported results after m-TESE retrieval in NOA patients from a non academic centre. Aim of our study was to find if there was a correlation between time to first infertility diagnosis and sperm retrieval rate.
Material and Methods: Complete data of 110 consecutive Caucasian males, suffering from primary infertility, were collected between January 2013 and October 2017. All patients were referred to our center for TESE, conventional (c-TESE) or microscopic (m-TESE); all procedures were performed by the same surgeon (AS). In September 2016 we started performing m-TESE. In our study we considered 30 consecutive NOA pts. Variables included were sperm retrieval rate, demographic data, cause of infertility, time to first infertility diagnosis, serum levels of hormones, histological findings. Univariate and multivariate logistic regression analyses were used to assess correlation between time to first infertility diagnosis and sperm retrieval rate.
Results: Thirty consecutive NOA pts with a median (range) age of 37 (26-53) years were included in the present study and submitted to m-TESE. Considering serum hormone median (range) levels were: FSH 12.7 mUI/mL (range 1.2-62.2), LH 6.5 mUI/mL (1.6-38.6), prolactin 12.1 ng/mL (4.5-22.4), total testosterone 4.49 ng/mL (1.0-10.4). All pts were checked for genetic abnormalities and Y chromosome microdeletions were detected in 10% of pts (3/30), while CFTR gene mutation in 6% (2/30 pts). Interestingly, mean time to first infertility diagnosis was 46.7 months (12-200). Positive sperm retrieval rate (p-SRR) for NOA group was 48.4%. Consensual testicular biopsy was performed in all NOA pts: severe hypospermatogenesis was found with maturation arrest in 6/30 pts (20%), Sertoli Cell Only Syndrome in 6/30 pts (16%), testicular atrophy in 6/30 pts (16%). At univariate and multivariate logistic regression analyses statistically significant correlation was found between p-SRR and time to first infertility diagnosis (respectively OR 2,8; I.C. 1,2-4,6 and OR 1,4; I.C 1.02-2,7, all p <0.01 ) but not with age at surgery (P=0,3).
Conclusions: Micro-TESE in NOA pts is a valid option even in older patients. In contrast with literature, age does not represent an absolute contraindication to surgery even if surgery is indicated as soon as possible in patients coming for primary infertility. Time to first infertility diagnosis is still delayed with a consecutive important effect on sperm retrieval rate.
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