(308) HISTOPATHOLOGICAL FINDINGS OF MICROTESE AND ITS ASSOCIATION WITH SPERM RETRIEVAL RATE IN PATIENTS WITH NON-OBSTRUCTIVE AZOOSPERMIA AND SEVERE OLIGOSPERMIA: A CASE SERIES
Authors: Fernandes H , Gouvea B , Figueiredo Filho R , Jordão P , Julio Junior H 
Published: December 2024

Abstract

Introduction
Testicular microdissection for sperm extraction (microTESE) in men with non-obstructive azoospermia and severe oligospermia is considered the gold standard for sperm retrieval. Non-obstructive azoospermia is characterized by the complete absence of sperm in the ejaculate, possibly due to problems in sperm production in the testicles. To be classified as severe oligospermia, a patient must have a sperm count of less than 1.5 million sperm per milliliter of ejaculate on their semen analysis. Both conditions can be caused by genetic, environmental, hormonal, or idiopathic factors. This technique represents a significant advancement in reproductive medicine, as it utilizes microscopes and precise surgical instruments to identify testicular areas where functional sperm may be present. The technique, combined with the surgeon’s expertise, has significantly increased the chance of finding viable sperm and improved the prognosis for male infertility treatment. There are other approaches, such as TESA (testicular sperm aspiration) and PESA (percutaneous epididymal sperm aspiration), but these have different indications from microTESE. After retrieval, viable sperm can be used for assisted reproductive techniques such as ICSI (intracytoplasmic sperm injection), which involves the direct injection of a single sperm into an egg. This technique is particularly important when sperm counts are very low.

Objective
This case series investigated the testicular histopathological characteristics of patients undergoing microTESE and aimed to correlate them with sperm retrieval rates.

Methods
This study conducted a retrospective observational study between May 2021 and May 2024 on 49 patients who underwent microTESE. All procedures took place in major hospitals in Rio de Janeiro-RJ and were consistently performed by the same two surgeons. For didactic purposes, histopathological findings were categorized into four subtypes: hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome, and normal. All patients included in the study had non-obstructive azoospermia or severe oligospermia. Age was not a criterion for inclusion or exclusion. There was no differentiation on unilateral or bilateral approaches.

Results
The results showed that most patients had testicular abnormalities (98.0%). The prevalence of abnormalities, as shown in Fig. 1, was as follows: hypospermatogenesis (55.1%), maturation arrest (20.4%), Sertoli cell-only syndrome (18.4%), Sertoli cell-only + maturation arrest (4.1%), and normal (2.0%). Hypospermatogenesis was associated with higher sperm retrieval rates (96.3%). In contrast, the retrieval rate for patients with maturation arrest was 50.0%, while only one patient with Sertoli cell-only syndrome was able to retrieve sperm (11.1%). Both patients who presented simultaneously with Sertoli cell-only and maturation arrest retrieved sperm (100.0%). In the single normal case, sperm retrieval was successful (100.0%). The overall retrieval rate was 71.4%, comparable to international results. These numbers are shown in Table 1.

Conclusions
This study supports the high sperm retrieval rates observed in microTESE. In our case series, the hypospermatogenesis subtype was the most prevalent and associated with a better prognosis. This study contributes to the understanding of histopathological characteristics and patient counseling regarding success rates.

Disclosure
No.