Dr. Schlegel: Outcomes of microdissection testicular sperm extraction in men with maturation arrest.

Bernie A, Trivedi N, Ramasamy R, Schlegel PN. Outcomes of microdissection testicular sperm extraction in men with maturation arrest. J Urol, 2014; 191(4): e733-e734. Presented at the 2014 Annual Meeting of the American Urologic Association, Orlando, FL.

Introductions and Objectives
Maturation arrest (MA) has been associated with worse prognosis for sperm retrieval in men with nonobstructive azoospermia (NOA). The objective of this study was to clarify the prognosis for men with MA and NOA who undergo microdissection testicular sperm extraction (micro-TESE).

Methods
A retrospective review of charts for 1068 consecutive patients with NOA, confirmed by analysis of 2 centrifuged semen samples, who underwent micro-TESE at a single center after a sample obtained on the day of planned micro-TESE confirmed absolute azoospermia, was performed. Men with complete AZFa or AZFb microdeletions were excluded. Testis volume was measured by physical examination with an orchidometer, and was taken as the mean value for patients with different testicular volumes. Follicle-stimulating hormone (FSH) was obtained within 2 months prior to micro-TESE. Only patients with 100% MA on diagnostic biopsy were included. Differences in sperm retrieval rate (SRR) were compared using a chi-square analysis.

Results
175 patients with mean age 35.6 ± 6.4 years were analyzed. Mean testis volume was 11.0 ± 5.4 cc. Mean FSH was 19.5 ± 14.6 IU/L. Overall SRR was 56.3%, with a clinical pregnancy rate of 55.1% and live birth rate of 47.5% among those with successful retrieval. SRR was similar among patients with testis volume <10cc compared to ≥10cc (62.7% vs 47.8%, p =0.07). Patients with FSH ≥10 IU/L had a higher SRR compared to patients with an FSH <10 IU/L (62.5% vs 38.2%, p=.0033). In patients with testis volume <10cc, those with an FSH ≥10 had the same likelihood of successful sperm retrieval compared to those with FSH<10 (63.5% vs 55.6%, p=0.7). In patients with testis volume ≥10cc, men with an FSH ≥10 were more likely to have successful sperm retrieval compared to men with an FSH<10 (60.9% vs 34.8%, p=0.02).

Conclusions
MA on diagnostic biopsy in men with NOA is associated with a sperm retrieval rate of 56% using micro-TESE at our center. However, men with larger volume testis and low FSH had the worse sperm retrieval rate of any men with diffuse maturation arrest. These observations are paradoxical to the typical assumptions that larger testis volume and lower FSH are associated with better testicular function.