370 BILATERAL DIFFERENTIAL TESTICULAR BIOPSIES IMPROVE TESE AND ICSI OUTCOMES IN NON-OBSTRUCTIVE AND OBSTRUCTIVE AZOOSPERMIC INFERTILE PATIENTS

Abstract

The goal of the present study was to evaluate the clinical significance of bilateral differential testicular biopsies (BDTB) to improve testicular sperm extraction (TESE) and ICSI outcomes in non-obstructive azoospermic (NOA) men. The male patients were divided into an obstructive azoospermic group (OAG, n = 40) and an NOA group (n = 50). The women in both groups had normal ovulatory cycles and reproductive hormone concentrations. BDTB were taken from upper, middle, and lower zones of the testes. At least 50 transverse histologic sections of seminiferous tubules were examined in each biopsy. The FSH, LH, and prolactin concentrations were significantly higher in the NOA group compared to the OAG (18.3 vs. 6.2 mIU mL^-1, 8.5 vs. 4.1 mIU mL^-1, and 9.6 vs. 6.4 ng mL^-1, respectively; P < 0.01), whereas the testosterone level and testicular size were significantly lower in the NOA group vs. the OAG (3.7 vs. 5.3 ng mL^-1 and 3.3 vs. 4.4 cm, respectively; P < 0.01). A new method (BDTB) for scoring testicular biopsies was used. This method is different from Johnson's method as SCO or TF or complete MA. Following positive BDTB results, TESE and ICSI were performed. The oocyte recovery rate/patient was 3.8% (154/40) and 3.6% (178/50) in the OAG and the NOA group, respectively (P > 0.05). The TESE-ICSI rates were 75.9% (117/154) in the OAG and 59.5% (106/178) in the NOA group (P < 0.005). The embryo cleavage rate was significantly higher in the OAG compared to the NOA group (98/117 = 83.8% vs. 66/106 = 62.3%, respectively; P < 0.005). The number of embryos transferred/patient in the OAG was significantly higher compared to that in the NOA group (2.5 vs. 1.3, respectively; P < 0.01). The embryo implantation rate per embryo transfer in the OAG was 52% (51/98) vs. 45.5% (30/66); P > 0.05. The clinical pregnancy rate per embryo transfer was 52.5% in the OAG and 40% in the NOA group (P > 0.05). It was concluded from the results of this study that both the BDTB and TESE were useful diagnostic and prognostic predictors of successful sperm retrieval for ICSI treatment in the non-obstructive and obstructive azoospermic male patients. The clinical embryo implantation rates were not significantly different between both groups (NOA group and OAG) which may indicate that the embryos of both groups have similar implantation potentials. Bilateral differential testicular biopsies were found to be positively correlated with the TESE and ICSI outcomes.