Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men

Özet

Objective: There is no clear consensus on which patients and how many of microscopic testicular spermextraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrievalrates and factors affecting these rates in men who underwent repeat mTESEs.Material and methods: A total of 346 patients who underwent mTESE for sperm retrieval were included inthe study. Patients were divided into groups according to the number of mTESE operations. Patients’ karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumeswere recorded from patient files. The sperm retrieval rates were compared between groups, and predictingfactors for successful sperm retrieval were evaluated.Results: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patientswho had not undergone previous TESE was higher than the group of patients that had undergone TESEfor 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, andp<0.001, respectively).Conclusion: Our results confirm the necessity for repeat mTESE operations to be performed by experiencedsurgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.