Browsing by Author "Ābele, Andris"

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    Testikulāro spermatozoīdu ekstrakcijas iespējas atbilstoši sēklinieku histoloģiski-morfoloģiskai atradnei pacientiem ar neobstruktīvu azoospermiju
    (Rīga Stradiņš University, 2024) Ābele, Andris; Ērenpreiss, Juris; Faculty of Residency; Rezidentūras studiju fakultāte
    INTRODUCTION. Infertility affects 1 in 6 couples, at least half of the cases are due to male factor infertility. In the past, men with azoospermia were considered sterile, but today they can become biological fathers thanks to medically assisted reproductive technology. Nonobstructive azoospermia (NOA) occurs when spermatogenesis is significantly impaired. Therefore, it is important to use effective surgical methods of sperm extraction and to identify the factors that influence this effectiveness. OBJECTIVES. To investigate the possibility of testicular sperm extraction in patients with NOA according to the histologic-morphologic findings of the testis. METHODS. This study consecutively recruited 54 NOA patients who were treated at the EGV clinic and underwent microsurgical (microTESE) or conventional testicular sperm extraction (cTESE) between 2018 and 2022. The results of demographic data, the presence of cryptorchidism and/or varicocele, changes in karyotype, the presence of Y-chromosome azoospermia factor (AZF), testosterone (T) and follicle-stimulating hormone (FSH) levels, semen analysis, intraoperative testicular sperm extraction rate and testicular biopsy were analyzed. Standard descriptive statistical methods were used to record study characteristics and data analysis using Microsoft Excel 2021 software. RESULTS. Out of 54 NOA patients, 48 (88.9%) underwent a microTESE and 6 (11.1%) underwent a cTESE procedure. Positive testicular sperm extraction was observed in 39 (72.2%) cases. The mean T values in the (+) sperm group is 5.43 (1.31-8.55) ng/mL; in the (-) sperm group 4.26 (2.10-10.50) ng/mL. The mean FSH values are 11.5 (9.5-13.5) U/L in the (+) sperm group and 24.3 (3.7-58.6) U/L in the (-) sperm group, which is a significant difference (p<0.001). For all microTESE/cTESE procedures, sperm extraction in the NOA-I group is 100% (n=25) successful, in the NOA-II group the sperm extraction rate is 85% (n=11), in the NOA-III group 27% (n=3) and in the NOA-SCO group no sperm extraction (n=5) is successful. CONCLUSIONS. MicroTESE is an effective method of surgical testicular sperm extraction in men with NOA, especially in hypospermatogenesis. The histologic-morphologic picture of the testis and the FSH serum level are important prognostic factors for testicular sperm extraction, regardless of age.