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Micro-TESE strategy in patients with NOA caused by AZFc deletion: synchronous or asynchronous?
Jiaming Mao1,2, Chenyao Deng2, Lianming Zhao2
1Department of Reproductive Medicine Center, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
Abstract:
In the treatment of infertile patients with non-obstructive azoospermia (NOA) caused by the deletion of the azoospermia factor c region (AZFc) on the Y chromosome, synchronous and asynchronous surgical strategies are discussed. Clinical data from NOA patients with the AZFc deletion who underwent micro-TESE were analyzed retrospectively. The sperm retrieval rate (SRR) and sperm utilization rate of synchronous and asynchronous operation groups were followed up and compared. The fertilization rate, high-quality embryo rate, clinical pregnancy rate, abortion rate, and cumulative live birth rate of ICSI in patients with successful sperm retrieval were compared between the two groups. The two groups had sperm utilization rates of 98.9% (93/94) and 50.0% (14/28), respectively. The asynchronous group's sperm consumption rates were much lower than those of the synchronous operation group. Fertilization rate, high-quality embryo rate, clinical pregnancy rate of fresh transfer cycle, abortion rate, and cumulative live birth rate of patients in the synchronous operation group with fresh sperm, and the asynchronous operation group with thawed sperm, respectively, were 30.6% vs 33.8%, 33.8% vs 40.7%, 40.0% vs 12.5%, 30.4% vs 7.1%. Between the two groups, there was no significant difference. This suggests that individuals with NOA caused by the AZFc deletion have a high possibility of successfully acquiring sperm using micro-TESE and ICSI to conceive their own offspring. Synchronous micro-TESE is recommended to improve sperm utilization rate and the cumulative live birth rate.
Insights
Synchronous microdissection testicular sperm extraction (micro-TESE) improves sperm utilization and live birth rates in infertile men with non-obstructive azoospermia (NOA) due to AZFc deletion. This strategy enhances conception success for affected individuals.
Area of Science:
- Reproductive Medicine
- Genetics
- Urology
Background:
- Non-obstructive azoospermia (NOA) affects infertile men, with Y chromosome AZFc region deletions being a significant genetic cause.
- Surgical sperm retrieval techniques like microdissection testicular sperm extraction (micro-TESE) offer hope for conception in NOA patients.
- The timing of sperm retrieval (synchronous vs. asynchronous) may impact treatment outcomes and sperm utilization.
Purpose of the Study:
- To compare the efficacy of synchronous and asynchronous micro-TESE strategies in NOA patients with AZFc deletions.
- To evaluate sperm retrieval and utilization rates between the two surgical approaches.
- To assess intracytoplasmic sperm injection (ICSI) outcomes, including fertilization, pregnancy, and live birth rates.
Main Methods:
- Retrospective analysis of clinical data from NOA patients with AZFc deletions undergoing micro-TESE.
- Comparison of sperm retrieval rate (SRR) and sperm utilization rate between synchronous and asynchronous groups.
- Evaluation of ICSI outcomes: fertilization rate, high-quality embryo rate, clinical pregnancy rate, abortion rate, and cumulative live birth rate.
Main Results:
- Sperm utilization rates were significantly higher in the synchronous group (98.9%) compared to the asynchronous group (50.0%).
- While fertilization and high-quality embryo rates showed no significant difference, the synchronous group had a higher clinical pregnancy rate (40.0% vs. 12.5%) with fresh sperm.
- The asynchronous group had a lower abortion rate (7.1%) and cumulative live birth rate (7.1%) compared to the synchronous group (30.4% and 30.6%, respectively).
Conclusions:
- NOA patients with AZFc deletions have a high probability of successful sperm retrieval via micro-TESE for conception using ICSI.
- Synchronous micro-TESE is recommended to maximize sperm utilization and improve cumulative live birth rates.
- The choice of surgical strategy significantly impacts sperm utilization and overall reproductive success in this patient population.
