Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T01:34:13.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Micro-TESE surgery combined with ICSI regimen in the treatment of non-obstructive azoospermia patients and its effect analysis

Published online by Cambridge University Press:  21 October 2022

Kaijuan Wang ,
Dondong Tang ,
Qi Zhu ,
Dandan Yang ,
Han Yang ,
Jing Peng ,
Ding Ding ,
Jing Wang ,
Qiushuang Wang  and
Yunxia Cao
...Show all authors
Kaijuan Wang
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Dondong Tang
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Qi Zhu
Affiliation:
Department of Biomedical Engineering, Anhui Medical University, Hefei 230022, Anhui, China
Dandan Yang
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Han Yang
Affiliation:
Department of Biomedical Engineering, Anhui Medical University, Hefei 230022, Anhui, China
Jing Peng
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China
Ding Ding
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China
Jing Wang
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Qiushuang Wang
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China
Yunxia Cao
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Beili Chen*
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
Zhiguo Zhang*
Affiliation:
Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei 230032, Anhui, China Anhui Provincial Institute of Translational Medicine, Hefei 230032, Anhui, China
*
Authors for correspondence: Beili Chen. Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China. Tel: +86 13855166952. E-mail: cbl0118@126.com. Zhiguo Zhang. Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China. Tel: +86 18155106683. E-mail: zzg_100@163.com
Authors for correspondence: Beili Chen. Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China. Tel: +86 13855166952. E-mail: cbl0118@126.com. Zhiguo Zhang. Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China. Tel: +86 18155106683. E-mail: zzg_100@163.com
Get access Rights & Permissions [Opens in a new window]

Summary

This study aimed to analyze the clinical effects of microdissection testicular sperm extraction (micro-TESE) surgery combined with an intracytoplasmic sperm injection (ICSI) regimen in the treatment of non-obstructive azoospermia (NOA) patients with different etiologies. In total, 128 NOA patients participated in this study, in which they received infertility treatment by micro-TESE surgery combined with an ICSI regimen, and all patients were divided into three groups [the Klinefelter syndrome (KS), the idiopathic and the secondary NOA groups]. In addition, the sperm retrieval rate (SRR), fertilization rate, embryo development status and clinical treatment effects were analyzed. Among the 128 NOA patients, the SRR of KS NOA patients was 48.65%, those of idiopathic and the secondary patients were 33.82% and 73.91%, respectively. Regardless of etiologies, there was no correlation with age, hormone value or testicular volume. Further analysis showed that the SRR of the KS group was positively related with testosterone (T) values, and the SRR of the secondary group had a positive relationship with follicle-stimulating hormone or luteinizing hormone values. In the subsequent clinical treatment, the retrieved sperm was subjected to ICSI and achieved good treatment effects, especially in the secondary group, and the implantation rate (55.56%) and clinical pregnancy rate (68.42%) were both higher than those of the idiopathic group (28.75% and 40.00%) and KS group (22.05% and 30.77%). Micro-TESE surgery combined with ICSI insemination is the most effective treatment regimen for NOA patients. The SRR of NOA patients with different etiologies are related to certain specific factors, and micro-TESE surgery seems to be the ideal and only way to have biological children.

Keywords

AzoospermiaClinical treatment effectsInfertilityIntracytoplasmic sperm injectionMicro-TESE surgeryNon-obstructive azoospermia
Type
Research Article
Information
Zygote , Volume 31 , Issue 1 , February 2023 , pp. 55 - 61
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The first three authors are joint first authors.

References

Achermann, A. P. P., Pereira, T. A. and Esteves, S. C. (2021). Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: Summary of current literature. International Urology and Nephrology, 53(11), 2193–2210. doi: 10.1007/s11255-021-02979-4 CrossRefGoogle ScholarPubMed
Adelman, C. A., Lolo, R. L., Birkbak, N. J., Murina, O., Matsuzaki, K., Horejsi, Z., Parmar, K., Borel, V., Skehel, J. M., Stamp, G., D’Andrea, A., Sartori, A. A., Swanton, C. and Boulton, S. J. (2013). HELQ promotes RAD51 paralogue-dependent repair to avert germ cell loss and tumorigenesis. Nature, 502(7471), 381–384. doi: 10.1038/nature12565 CrossRefGoogle ScholarPubMed
Chiba, K., Enatsu, N. and Fujisawa, M. (2016). Management of non-obstructive azoospermia. Reproductive Medicine and Biology, 15(3), 165–173. doi: 10.1007/s12522-016-0234-z CrossRefGoogle ScholarPubMed
Cocuzza, M., Alvarenga, C. and Pagani, R. (2013). The epidemiology and etiology of azoospermia. Clinics (São Paulo), 68, Suppl. 1, 15–26. doi: 10.6061/clinics/2013(sup01)03 CrossRefGoogle ScholarPubMed
Corona, G., Pizzocaro, A., Lanfranco, F., Garolla, A., Pelliccione, F., Vignozzi, L., Ferlin, A., Foresta, C., Jannini, E. A., Maggi, M., Lenzi, A., Pasquali, D., Francavilla, S. and Klinefelter ItaliaN Group (KING). (2017). Sperm recovery and ICSI outcomes in Klinefelter syndrome: A systematic review and meta-analysis. Human Reproduction Update, 23(3), 265–275. doi: 10.1093/humupd/dmx008 CrossRefGoogle ScholarPubMed
Devroey, P., Liu, J., Nagy, Z., Goossens, A., Tournaye, H., Camus, M., Van Steirteghem, A. and Silber, S. (1995). Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Human Reproduction, 10(6), 1457–1460. doi: 10.1093/humrep/10.6.1457 CrossRefGoogle ScholarPubMed
Ding, D., Wang, Q., Li, X., Chen, B., Zou, W., Ji, D., Hao, Y., Xue, R., Zou, H., Wei, Z., Zhou, P., Cao, Y. and Zhang, Z. (2020). Effects of different polyvinyl pyrrolidone concentrations on intracytoplasmic sperm injection. Zygote, 14, 1–6. doi: 10.1017/S0967199419000820 Google Scholar
Esteves, S. C. and Varghese, A. C. (2012). Laboratory handling of epididymal and testicular spermatozoa: What can be done to improve sperm injections outcome. Journal of Human Reproductive Sciences, 5(3), 233–243. doi: 10.4103/0974-1208.106333 CrossRefGoogle ScholarPubMed
Flannigan, R., Bach, P. V. and Schlegel, P. N. (2017). Microdissection testicular sperm extraction. Translational Andrology and Urology, 6(4), 745–752. doi: 10.21037/tau.2017.07.07 CrossRefGoogle ScholarPubMed
Gardner, D. K., Lane, M., Stevens, J., Schlenker, T. and Schoolcraft, W. B. (2000). Blastocyst score affects implantation and pregnancy outcome: Towards a single blastocyst transfer. Fertility and Sterility, 73(6), 1155–1158. doi: 10.1016/s0015-0282(00)00518-5 CrossRefGoogle ScholarPubMed
Hao, Y., Chen, D., Zhang, G., Zhang, Z., Liu, X., Zhou, P., Wei, Z., Xu, X., He, X., Xing, L., Lv, M., Ji, D., Chen, B., Zou, W., Wu, H., Liu, Y. and Cao, Y. (2020). Successful clinical application of pre-implantation genetic diagnosis for infantile neuroaxonal dystrophy. Experimental and Therapeutic Medicine, 19(2), 956–964. doi: 10.3892/etm.2019.8302 Google ScholarPubMed
Li, X., Mu, Y., Elshewy, N., Ding, D., Zou, H., Chen, B., Chen, C., Wei, Z., Cao, Y., Zhou, P. and Zhang, Z. (2021). Comparison of IVF and IVM outcomes in the same patient treated with a modified IVM protocol along with an oocytes-maturing system containing melatonin: A pilot study. Life Sciences, 264, 118706. doi: 10.1016/j.lfs.2020.118706 CrossRefGoogle ScholarPubMed
Lu, J. C., Huang, Y. F. and Lü, N. Q. (2010). [WHO Laboratory Manual for the Examination and processing of Human Semen: Its applicability to andrology laboratories in China]. Zhonghua Nan Ke Xue, 16(10), 867–871.Google ScholarPubMed
Osaka, A., Iwahata, T., Kobori, Y., Shimomura, Y., Yoshikawa, N., Onota, S., Yamamoto, A., Ide, H., Sugimoto, K. and Okada, H. (2020). Testicular volume in non-obstructive azoospermia with a history of bilateral cryptorchidism may predict successful sperm retrieval by testicular sperm extraction. Reproductive Medicine and Biology, 19(4), 372–377. doi: 10.1002/rmb2.12338 CrossRefGoogle ScholarPubMed
Schlegel, P. N. (1999). Testicular sperm extraction: Microdissection improves sperm yield with minimal tissue excision. Human Reproduction, 14(1), 131–135. doi: 10.1093/humrep/14.1.131 CrossRefGoogle ScholarPubMed
Tharakan, T., Luo, R., Jayasena, C. N. and Minhas, S. (2021). Non-obstructive azoospermia: Current and future perspectives. Faculty Reviews, 10, 7. doi: 10.12703/r/10-7 CrossRefGoogle ScholarPubMed
Tiseo, B. C., Hayden, R. P. and Tanrikut, C. (2015). Surgical management of nonobstructive azoospermia. Asian Journal of Urology, 2(2), 85–91. doi: 10.1016/j.ajur.2015.04.020 CrossRefGoogle ScholarPubMed
Tomás, C., Orava, M., Tuomivaara, L. and Martikainen, H. (1998). Low pregnancy rate is achieved in patients treated with intracytoplasmic sperm injection due to previous low or failed fertilization in in-vitro fertilization. Human Reproduction, 13(1), 65–70. doi: 10.1093/humrep/13.1.65 CrossRefGoogle ScholarPubMed
Tsujimura, A. (2007). Microdissection testicular sperm extraction: Prediction, outcome, and complications. International Journal of Urology, 14(10), 883–889. doi: 10.1111/j.1442-2042.2007.01828.x CrossRefGoogle ScholarPubMed
Vahidi, S., Horoki, A. Z., Talkhooncheh, M. H., Jambarsang, S., Marvast, L. D., Sadeghi, A. and Eskandarian, S. (2021). Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: A retrospective study. International Journal of Reproductive Biomedicine, 19(9), 781–788. doi: 10.18502/ijrm.v19i9.9710 Google ScholarPubMed
Verza, S. and Esteves, S. C. (2019). PESA/MESA/TESA/TESE sperm processing. In Nagy, Z. P., Varghese, A. C. & Agarwal, A. (eds), In vitro fertilization: A textbook of current and emerging methods and devices (pp. 313–334). Springer International Publishing.CrossRefGoogle Scholar
World Health Organization (2001). Manuale di laboratorio della WHO per l’esame del liquido seminale umano e dell’interazione tra spermatozoi e muco cervicale [Laboratory manual of the WHO for the examination of human semen and sperm-cervical mucus interaction]. Annali dell’Istituto superiore di sanita, 37(1), I–123.Google Scholar
Wu, X., Lin, D., Sun, F. and Cheng, C. Y. (2021). Male infertility in humans: An update on non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). Advances in Experimental Medicine and Biology, 1288, 161–173. doi: 10.1007/978-3-030-77779-1_8 CrossRefGoogle ScholarPubMed
Zhang, Z., Wang, T., Hao, Y., Panhwar, F., Chen, Z., Zou, W., Ji, D., Chen, B., Zhou, P., Zhao, G. and Cao, Y. (2017). Effects of trehalose vitrification and artificial oocyte activation on the development competence of human immature oocytes. Cryobiology, 74, 43–49. doi: 10.1016/j.cryobiol.2016.12.004 CrossRefGoogle ScholarPubMed

Wang et al. supplementary material

Wang et al. supplementary material

Download Wang et al. supplementary material(Video)
Video 12.8 MB