Testicular Sperm Extraction with Intracytoplasmic Sperm Injection is Successful for the Treatment of Nonobstructive Azoospermia Associated with Cryptorchidism
We evaluated the results of testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) in men with nonobstructive azoospermia (NOA) associated with cryptorchidism.
Materials and Methods:
A total of 321 TESE attempts were done in 275 men with confirmed nonobstructive azoospermia to recover spermatozoa for ICSI between November 1995 and December 2001. Of these patients 38 with a diagnosis of cryptorchidism underwent 47 sperm extraction attempts. The remaining 237 men with a total of 274 associated TESE attempts had various other etiologies for NOA. The outcome measures studied were the sperm retrieval, fertilization, pregnancy and miscarriage rates after ICSI. Serum follicle stimulating hormone (FSH), testicular volume and age at orchiopexy (in the cryptorchid group) were examined as predictive factors for sperm recovery.
In the cryptorchid cohort spermatozoa were successfully retrieved at 35 of 47 TESE attempts (74%) with fertilization in 214 of 347 metaphase II oocytes (62%). Clinical pregnancies resulted for 16 of 35 cycles (46%) when sperm were retrieved, with ongoing pregnancies or deliveries in 15 of the 35 (43%). Spermatozoa recovery correlated with testicular volume (p <0.05) and patient age at orchiopexy (p <0.001) but it was independent of serum FSH. In the noncryptorchid subgroup spermatozoa were successfully retrieved at 160 of 274 TESE attempts (58%) with fertilization in 983 of 1,657 metaphase II oocytes (59%). Clinical pregnancies were documented for 71 of 160 cycles (44%) when sperm were retrieved, with ongoing pregnancies or deliveries in 58 of 160 the (36%). Spermatozoa recovery was independent of testicular volume and serum FSH. Patients with a history of cryptorchidism had better TESE sperm retrieval rates (p <0.05) but no significant difference in the fertilization, pregnancy or miscarriage rate.
TESE with ICSI is a successful treatment modality for men with NOA associated with cryptorchidism. Spermatozoa were retrieved in 74% of attempts with a resulting clinical pregnancy in 46% of these cases. These results are comparable if not better to those in noncryptorchid patients with NOA. Testicular volume and age at orchiopexy were identified as independent predictors of sperm retrieval for men with a history of cryptorchidism.
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From the James Buchanan Brady Urology Foundation, Department of Urology, Center for Male Reproductive Medicine and Microsurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University (JDR, PNS) and The Population Council, Center for Biomedical Research (PNS), New York, New York