Non-Obstrüktif Azoospermide Sperm Bulmayı Predikte Eden Faktörler

Abstract

Azoospermi has prevalance of 1% among general male population (25,1,158) and 10-15 %among infertile male (26,1,3,25,158). Azoospermia generally classified as obstructive 20-40% (normal sperm production) and non obstructive azoospermia 60-80% (decreased or absent sperm production) (4). The only way of azoospermik man to father a baby is testicular sperm extraction (11). An unsuccessful sperm recovery procedure has important emotional and financial implications as well as physiological complications such as devascularization and fibrosis of the testis, We therefore studied the sperm recovery in this group and evaluated clinical parameters predicting successful sperm retrieval and the outcome of ICSI. NOA Patients whose infertility follow-up and management performed at Hacettepe University Faculty of Medicine, Department of Reproductive Endocrinology and İnfertility Outpatient Clinic, between 1 January 2002 and 31 December 2013 were enrolled. A total of 210 non-obstructive azoospermic men underwent a sperm recovery procedure. The predictive value of clinical parameters such as age, testicular volume, hormon assay like FSH, LH, testosterone, TSH, PRL, AMH genetic evaluation for klinefelter syndrome and Y-chromosome microdeletion,presence of history of medical disease and /or surgical intervention ,history of sexually transmitted disease or exposure to gonadotoxins.All evaluated and compared with successful TESE result and then after with successful pregnancy outcomes. From a total of 210 patient with NOA testicular spermatozoa were recovered in 73 patients (35%). The mean age of the patients with a positive sperm recovery was 32.9 5.5 years versus 32.2 5.9 for those where no spermatozoa were found. The mean testicular volume of the right testis and left testis of patients with spermatozoa found was 14.1 13.2 ml, 14.8 ml respectively versus 14.9 ml and 14.8 ml respectively,The mean FSH value for patients with successful and unsuccessful sperm recovery, respectively, was 13.8 11.9 IU/l versus 20.4 13.6 IU/l .Among 210 NOA patients only145 patients have testicular biopsy and of them 2 patient have normal results, 75 patients have SCOS, 39 patients have maturation arrest, 25 patients have hipospermatogenesis,and 4 of them have peritubular hyalinization and fibrosis, successful TESE was performed in 1 (%50) patient with normal biopsy result,19patients (%25.3) with SCOS, 10 patients (%25.6) with maturation arrest, 16 patients (%64) with hipospermatogenesis, and no patient with peritubular hyalinization and fibrosis, the remainder have no successful TESE results. All clinical and biological parameters examined (except FSH) failed to predict the outcome of the testicular sperm extraction. In our study FSH can give idea about predicting presence of sperm in TESE. (p-value 0.01, cut off value: 9.75, sensitivity:%77, specifity:%51, AUC was 0.66, Odds ratio: 1.046, CI:1.017-1.075).