Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Front Endocrinol (Lausanne). 2024 Oct 10;15:1466675. doi: 10.3389/fendo.2024.1466675. eCollection 2024.
The management of Non-Obstructive (NOA) Azoospermia or Obstructive Azoospermia (OA) patients relies on testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI). In NOA patients the sperm recovery is successful in only 50% of cases and therefore the ability to predict those patients with a high probability of achieving a successful sperm retrieval would be a great value in counselling the patient and his partner. Several studies tried to suggest predictors of a positive TESE (e.g. FSH concentration), but most concluded that diagnostic testicular biopsy (histology) is best.
This is a retrospective analysis of 526 TESE patients. After the extraction of the testis, the resulting sample was immediately given to the embryologist, who examined the tubules for sperm cryopreservation. During the same procedure, a different specimen was destined to the histological analysis. The comparison between the two methodological approaches was carried out through a score.
Concordance between TESE and testicular histology outcomes was found in 70,7% of patients; discordance was found in 29,3% of patients. Among the discordance outcomes, in approximately 95% we found at least 1 sperm in the TESE retrieval, while the histology report did not find any spermatozoa or found not enough compared to our evaluation; in only 5% of cases we did not find any spermatozoa or found not enough compared to what was detected in the testicular histology.
Based on our experience, to increase diagnostic accuracy, a larger biopsy should be sent to the histopathology laboratory; another option may be to use TESE cell suspension (the same embryologists employ for cryopreservation) for cytological evaluation of spermatogenesis.
非梗阻性（NOA）无精子症或梗阻性无精子症（OA）患者的治疗依赖于睾丸精子提取（TESE），然后进行胞浆内精子注射（ICSI）。在 NOA 患者中，只有 50%的患者能够成功回收精子，因此，能够预测那些极有可能成功获取精子的患者，对于患者及其伴侣的咨询将具有重要价值。已经有几项研究试图提出 TESE 阳性的预测因素（例如 FSH 浓度），但大多数研究得出的结论是，诊断性睾丸活检（组织学）是最佳的。
这是对 526 例 TESE 患者的回顾性分析。睾丸取出后，立即将提取的样本交给胚胎学家，胚胎学家检查小管以进行精子冷冻保存。在同一程序中，另一个不同的样本被用于组织学分析。通过评分比较两种方法的结果。
TESE 与睾丸组织学结果的一致性在 70.7%的患者中发现；在 29.3%的患者中发现不一致。在不一致的结果中，大约 95%的患者在 TESE 中至少发现了 1 个精子，而组织学报告未发现任何精子或发现的精子数量与我们的评估相比不足；在仅 5%的患者中，我们未发现任何精子或发现的精子数量与睾丸组织学中检测到的相比不足。
根据我们的经验，为了提高诊断准确性，应向组织病理学实验室发送更大的活检样本；另一种选择可能是使用 TESE 细胞悬液（胚胎学家用于冷冻保存的相同细胞悬液）对生精细胞进行细胞学评估。
