Successful retrieval of testicular spermatozoa by microdissection (MICRO-TESE) in nonobstructive azoospermia is related to testicular histology.

[P-594] SUCCESSFUL RETRIEVAL OF TESTICULAR SPERMATOZOA BY MICRODISSECTION (MICRO-TESE) IN NONOBSTRUCTIVE AZOOSPERMIA IS RELATED TO TESTICULAR HISTOLOGY.

S. C. Esteves, S. Verza Jr., A. Prado Gomes. ANDROFERT-Centro de Referência em Infertilidade Masculina, Campinas, Brazil

Objective: Several studies report higher sperm retrieval rate (SRR) by microdissection testicular sperm extraction (Micro-TESE) than by conventional TESE in nonobstructive azoospermic men. The objective of this study was to analyze SRR by micro-TESE in relation to testicular histology.

Design: Retrospective clinical study.

Materials and methods: Fourty-two men with nonobstructive azoospermia underwent micro-TESE from October/02 to May/05. Of them, one had a AZFc microdeletion and one a nonmosaic Klinefelter syndrome. Testicular parenchyma (single piece measuring ~3X3X3mm) for histological evaluation was obtained prior or during micro-TESE. Testicular biopsies were classified based on the predominant histologic pattern as follows: (a) Sertoli-cell only (SCO), (b) Maturation arrest (MA) and (c) Hypospermatogenesis (HYPO). The mean age and serum FSH values in this series were 35.8 years and 27.3, 25.0 e 21.5 mIU/mL in each group, respectively. Fourteen patients underwent ICSI using testicular spermatozoa or elongated spermatids.

Results: Overall, testicular spermatozoa was found in 52.4% (22/42) micro-TESE cases. Hypospermatogenesis, MA and SCO were identified on histology in 7, 5 and 30 patients, respectively. The SRR in relation to testicular histology was 100% (7/7) for HYPO, 75% (3/4) for MA and 32.2% (10/31) for SCO. In another 10 SCO patients, only elongated spermatids have been found (32.2%). Sixteen ICSI cycles were performed, 11 using testicular spermatozoa and 5 with elongated spermatids. Fertilization, cleavage and good quality embryo rates using spermatozoa and spermatids were 54.4% and 42.3%, 97.1% and 93.3%, 52.8% and 27.7%, respectively. Pregnancy and miscarriage rates for ICSI cycles involving testicular spermatozoa were 72.7% (8/11) and 50% (4/8). No pregnancies were obtained in ICSI cycles using elongated spermatids. In 11 out of 22 (50.0%) successful sperm retrieval by micro-TESE, exceeding and adequate material for cryopreservation was obtained. In all of them, HYPO or MA were seen on testis histology.

Conclusion: Testicular histology is predictable of the chance of finding spermatozoa by micro-TESE in men with nonobstructive azoospermia. Hypospermatogenesis and SCO had the best and worst prognosis either for SSR and for cryopreservation of exceeding spermatozoa, respectively. Adequate pregnancy rates are achieved by ICSI in such cases, but miscarriage is frequent.