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Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia

  • Urology – Original Paper
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Abstract

Purpose

We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates.

Methods

A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared.

Results

Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05).

Conclusions

To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic–pituitary–gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

The authors acknowledge Andrology Working Group of Society of Urologic Surgery-Turkey (SUST) for their kindly and endless support.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey

    Eray Hasirci & Erman Ceyhan

  2. Cerrahpasa Faculty of Medicine, Department of Urology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Mehmet Hamza Gultekin

  3. Faculty of Medicine, Department of Urology, Baskent University, Adana, Turkey

    Mehmet Vehbi Kayra

  4. Department of Urology, Ankara Bilkent City Hospital, Ankara, Turkey

    Yalcin Kizilkan

  5. Gelibolu Sehit Koray Onay State Hospital, Urology Clinic, Canakkale, Turkey

    Omer Yildirim

  6. Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey

    Mesut Altan

  7. Faculty of Medicine, Department of Urology, Eskisehir Osmangazi University, Eskisehir, Turkey

    Iyimser Ure

  8. Etlik Zubeyde Hanim Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey

    Tufan Cicek

  9. Medline Hospital, Adana, Turkey

    Cem Sah

  10. Faculty of Medicine, Department of Biostatistics, Baskent University, Ankara, Turkey

    Caner Incekas

  11. Department of Urology, Private EPC Hospital, Adana, Turkey

    Umit Gul

  12. UroCentre Urology Clinic, Adana, Turkey

    Tahsin Turunc

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  1. Eray Hasirci
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Contributions

EH and EC worked on concept and design. They also undertook literature search and writing tasks. MHG, MVK, YK, OY, MA, IU, TC and CS were involved in data collection and processing. CI worked on statistical analysis. UG and TT served as supervisors.

Corresponding author

Correspondence to Eray Hasirci.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was approved by the Medical and Health Sciences Research Board of Baskent University (Project number: KA22/491).

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Hasirci, E., Ceyhan, E., Gultekin, M.H. et al. Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04074-w

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