ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil.
Fertil Steril. 2024 Oct;122(4):636-647. doi: 10.1016/j.fertnstert.2024.06.013. Epub 2024 Jun 22.
To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA).
A cohort study.
University-affiliated male reproductive health center.
PATIENT(S): A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history.
INTERVENTION(S): Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation.
MAIN OUTCOME MEASURE(S): A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success.
RESULT(S): The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic.
CONCLUSION(S): This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair.
NCT05110391.
探讨影响低促性腺激素型非梗阻性无精子症（NOA）患者睾丸显微取精术（micro-TESE）成功的因素。
队列研究。
大学附属男性生殖健康中心。
2014 年至 2021 年间，共 616 例低促性腺激素型 NOA 且总睾酮（T）水平<350ng/dL 的患者连续接受了 micro-TESE。所有患者均无既往精子获取（SR）史。
年龄 23-55 岁的患者接受了全面的临床、实验室和组织病理学诊断评估，以确定 NOA，并根据预 SR 激素刺激进一步分为两个队列。
多变量逻辑回归分析探讨了患者变量与 micro-TESE 成功之间的关系，micro-TESE 成功定义为提取标本中存在有活力的精子。计算调整后的优势比（aOR）和 95%置信区间（CI）以评估 SR 成功与相关预测因素之间的关系。比较接受或不接受激素刺激的患者的 SR 率，并进行逻辑回归分析评估基础卵泡刺激素水平（即正常促性腺激素和高促性腺激素类）对 SR 成功的影响。
总体 micro-TESE 成功率为 56.6%。基础卵泡刺激素水平（aOR，0.97；95%CI，0.94-0.99）、预 SR 激素刺激（aOR，2.54；95%CI，1.64-3.93）、临床精索静脉曲张（aOR，0.05；95%CI，0.01-0.51）、既往精索静脉曲张手术史（aOR，2.55；95%CI，1.26-5.16）和睾丸组织病理学是 SR 成功的独立预测因素。在接受激素预处理的患者中，预 micro-TESE T 水平和 delta T（T 水平从基线的绝对增加）与 SR 成功相关。micro-TESE 前 T 水平为 418.5ng/dL（曲线下面积值：0.78）和 delta T 为 258ng/dL（曲线下面积值：0.76）可区分出 SR 结果阳性和阴性的患者。亚组分析表明，预 SR 激素刺激对正常促性腺激素患者比高促性腺激素患者更有益。
本研究强调了临床因素与低促性腺激素型 NOA 患者 micro-TESE 成功之间的关系。尽管因果关系尚未确立，但我们的研究结果表明，这些患者可能受益于预 SR 干预，特别是激素刺激和精索静脉曲张修复。
NCT05110391。
