BackgroundThe 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 here 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.MethodsThis 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.ResultsConcordance 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 opheliasmuse.com only 5% of cases we did not find any spermatozoa or found not enough compared to what was detected in the testicular histology.ConclusionBased 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.