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Predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature

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Abstract

Intracytoplasmic sperm injection (ICSI), combined with surgical sperm retrieval (SR) techniques, is the sole option for patients with non-obstructive azoospermia to achieve fertility; however, with suboptimal results. Given the variability in clinical presentation, the potential role of factors that can predict the likelihood of successful testicular SR needs to be clarified. This article summarizes the current evidence concerning the variables predicting SR success in non-obstructive azoospermic patients with spermatogenic failure. For this, we used 60 articles, including 46 original papers and six meta-analyses. Clinical and laboratory factors, as well as adjuvant therapies and surgical retrieval methods, were the factors most commonly investigated. We found that Klinefelter syndrome, Y chromosome microdeletions in regions AZFa/b, and Sertoli cell-only histopathology were associated with reduced SR success. By contrast, testis volume > 12.5 ml, history of cryptorchidism, use of micro-TESE as the sperm retrieval method, and adjuvant therapy were associated with improved SR success. None of the predictors, alone or combined, provide definitive information about the chances of harvesting sperm in men with non-obstructive azoospermia, except for Y chromosome microdeletions in regions AZFa/b. In the latter, SR success is virtually nil. We conclude that SR outcomes in men with non-obstructive azoospermia are difficult to predict based on the existing variables. Although several predictors can be used for patient counseling, their clinical value is limited to either ensure SR success or discourage reproductive urologists from recommending SR to men with non-obstructive azoospermia seeking fertility. A notable exception includes the deletions involving the regions AZFa and/or AZFb of the Y chromosome; the affected patients should be counseled against undergoing SR.

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Authors and Affiliations

  1. Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan

    Muhammad A. Arshad

  2. Nishter Hospital, Multan, Pakistan

    Muhammad A. Arshad

  3. Department of Urology, Hamad Medical Corporation, Doha, Qatar

    Ahmad Majzoub

  4. Weill Cornell Medicine- Qatar, Doha, Qatar

    Ahmad Majzoub

  5. ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, São Paulo, 13075-460, Brazil

    Sandro C. Esteves

  6. Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil

    Sandro C. Esteves

  7. Faculty of Health, Department of Clinical Sciences, Aarhus University, Aarhus, Denmark

    Sandro C. Esteves

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  3. Sandro C. Esteves
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MAA performed the literature search; MAA and AM assessed the retrieved articles for inclusion in this review; MAA, AM, and SCE drafted the manuscript. AM and SE critically reviewed the manuscript. All authors approved the submitted version.

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Correspondence to Sandro C. Esteves.

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Arshad, M.A., Majzoub, A. & Esteves, S.C. Predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature. Int Urol Nephrol 52, 2015–2038 (2020). https://doi.org/10.1007/s11255-020-02529-4

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