Akash A Kapadia, Garrick M Greear, Tony Chen, David Ball, Robert D McClure, Kevin A Ostrowski, Tristan M Nicholson, Theodore Crisostomo-Wynne, Marah C Hehemann, Thomas J Walsh
{"title":"在非阻塞性无精子症中，睾丸定位引导下的精子回收与预先microTESE：精子回收、怀孕和活产率的比较。","authors":"Akash A Kapadia, Garrick M Greear, Tony Chen, David Ball, Robert D McClure, Kevin A Ostrowski, Tristan M Nicholson, Theodore Crisostomo-Wynne, Marah C Hehemann, Thomas J Walsh","doi":"10.21037/tau-24-362","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of men with NOA over a 10-year period from 2010 to 2019. The primary outcome was success of SR with secondary outcomes of pregnancy, and live-birth rates.</p><p><strong>Results: </strong>Ninety men were included in the analysis. 60 in the FNAM group in 30 having upfront microTESE. In the FNAM group, 34/60 (56.7%) patients had positive fine needle aspiration (FNA) map for spermatogenesis. Of these 20/31 (64.5%) had FNAM-guided TESA/E, and 11/31 (35.5%) had microTESE. SR was successful in 30 of 31 men (96.8%). Overall SR rate was 54.4% and 56.7% in the FNAM group and upfront microTESE, respectively. There was no statistical difference in SR (P=0.65). The FNAM group had pregnancy and live-birth rates of 42.1% and 36.8%, respectively. The upfront microTESE group had pregnancy and live-birth rates of 36.7% each. χ<sup>2</sup> analysis revealed no statistical difference for both pregnancy (P=0.76) and live-birth rates (P=0.75).</p><p><strong>Conclusions: </strong>FNAM carries high predictability and reliability in SR and can be performed prior to microTESE in NOA patients without change in fertility outcomes.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 12","pages":"2672-2680"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732293/pdf/","citationCount":"0","resultStr":"{\"title\":\"Testicular mapping-guided sperm retrieval <i>vs.</i> upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live-birth rates.\",\"authors\":\"Akash A Kapadia, Garrick M Greear, Tony Chen, David Ball, Robert D McClure, Kevin A Ostrowski, Tristan M Nicholson, Theodore Crisostomo-Wynne, Marah C Hehemann, Thomas J Walsh\",\"doi\":\"10.21037/tau-24-362\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of men with NOA over a 10-year period from 2010 to 2019. The primary outcome was success of SR with secondary outcomes of pregnancy, and live-birth rates.</p><p><strong>Results: </strong>Ninety men were included in the analysis. 60 in the FNAM group in 30 having upfront microTESE. In the FNAM group, 34/60 (56.7%) patients had positive fine needle aspiration (FNA) map for spermatogenesis. Of these 20/31 (64.5%) had FNAM-guided TESA/E, and 11/31 (35.5%) had microTESE. SR was successful in 30 of 31 men (96.8%). Overall SR rate was 54.4% and 56.7% in the FNAM group and upfront microTESE, respectively. There was no statistical difference in SR (P=0.65). The FNAM group had pregnancy and live-birth rates of 42.1% and 36.8%, respectively. The upfront microTESE group had pregnancy and live-birth rates of 36.7% each. χ<sup>2</sup> analysis revealed no statistical difference for both pregnancy (P=0.76) and live-birth rates (P=0.75).</p><p><strong>Conclusions: </strong>FNAM carries high predictability and reliability in SR and can be performed prior to microTESE in NOA patients without change in fertility outcomes.</p>\",\"PeriodicalId\":23270,\"journal\":{\"name\":\"Translational andrology and urology\",\"volume\":\"13 12\",\"pages\":\"2672-2680\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-12-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732293/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational andrology and urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tau-24-362\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ANDROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational andrology and urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tau-24-362","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/28 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ANDROLOGY","Score":null,"Total":0}
Testicular mapping-guided sperm retrieval vs. upfront microTESE in non-obstructive azoospermia: a comparison of sperm retrieval, pregnancy and live-birth rates.
Background: Sperm extraction by Microscopic Testicular Sperm Extraction (microTESE) has become the standard of care for sperm retrieval (SR) in men with non-obstructive azoospermia (NOA) but is costly and has a 40-50% chance of failure. Fine needle aspiration mapping (FNAM) can be performed prior to microTESE as a predictor of success to reduce the likelihood of failure to retrieve sperm but there is limited evidence that directly compares these methods. The objective of this study was to compare success rate of SR, pregnancy, and live birth rates in men who underwent upfront microTESE versus FNAM.
Methods: We performed a retrospective cohort study of men with NOA over a 10-year period from 2010 to 2019. The primary outcome was success of SR with secondary outcomes of pregnancy, and live-birth rates.
Results: Ninety men were included in the analysis. 60 in the FNAM group in 30 having upfront microTESE. In the FNAM group, 34/60 (56.7%) patients had positive fine needle aspiration (FNA) map for spermatogenesis. Of these 20/31 (64.5%) had FNAM-guided TESA/E, and 11/31 (35.5%) had microTESE. SR was successful in 30 of 31 men (96.8%). Overall SR rate was 54.4% and 56.7% in the FNAM group and upfront microTESE, respectively. There was no statistical difference in SR (P=0.65). The FNAM group had pregnancy and live-birth rates of 42.1% and 36.8%, respectively. The upfront microTESE group had pregnancy and live-birth rates of 36.7% each. χ2 analysis revealed no statistical difference for both pregnancy (P=0.76) and live-birth rates (P=0.75).
Conclusions: FNAM carries high predictability and reliability in SR and can be performed prior to microTESE in NOA patients without change in fertility outcomes.
期刊介绍：
ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.
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