Ranjith Ramasamy1, Nikunj N Trivedi1, Jennifer E Reifsnyder1, Gianpiero D Palermo1, Zev Rosenwaks1, Peter N Schlegel2. 1. Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. 2. Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. Electronic address: pnschleg@med.cornell.edu.
Abstract
OBJECTIVE: To evaluate the effect of male age on the outcome of microdissection testicular sperm extraction (micro-TESE) and assisted reproductive technology. DESIGN: Clinical retrospective study. SETTING: Center for reproductive medicine at a tertiary university hospital. PATIENT(S): One thousand sixty-seven men with nonobstructive azoospermia. INTERVENTION(S): Micro-TESE, with intracytoplasmic sperm injection when sperm found. MAIN OUTCOME MEASURE(S): Sperm retrieval and clinical pregnancy. RESULT(S): Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men <50, (73% in men ≥50, 56% in men <50). Of the 44 men ≥50 years old, men who had successful micro-TESE had larger mean testis volume (20.8 cc vs. 12.5 cc), a higher frequency of hypospermatogenesis (5.6% vs. 0%), and a lower frequency of Sertoli cells only (12.5% vs. 80%) on diagnostic biopsy. Clinical pregnancy rates were lower in partners of men ≥50 than in partners of men <50 (48% in men <50, 25% in men ≥50). Lower pregnancy rates may be at least partially explained by older female partners for men ≥50 compared to men <50 (mean age 38.0 vs. 36.2 years). Sperm were successfully retrieved across all age groups, and there was no upper male age limit above which sperm could not be retrieved. CONCLUSION(S): Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner <35 years old. Some older men with azoospermia may have secondary azoospermia with hypospermatogenesis, explaining the high sperm retrieval rate.
OBJECTIVE: To evaluate the effect of male age on the outcome of microdissection testicular sperm extraction (micro-TESE) and assisted reproductive technology. DESIGN: Clinical retrospective study. SETTING: Center for reproductive medicine at a tertiary university hospital. PATIENT(S): One thousand sixty-seven men with nonobstructive azoospermia. INTERVENTION(S): Micro-TESE, with intracytoplasmic sperm injection when sperm found. MAIN OUTCOME MEASURE(S): Sperm retrieval and clinical pregnancy. RESULT(S): Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men <50, (73% in men ≥50, 56% in men <50). Of the 44 men ≥50 years old, men who had successful micro-TESE had larger mean testis volume (20.8 cc vs. 12.5 cc), a higher frequency of hypospermatogenesis (5.6% vs. 0%), and a lower frequency of Sertoli cells only (12.5% vs. 80%) on diagnostic biopsy. Clinical pregnancy rates were lower in partners of men ≥50 than in partners of men <50 (48% in men <50, 25% in men ≥50). Lower pregnancy rates may be at least partially explained by older female partners for men ≥50 compared to men <50 (mean age 38.0 vs. 36.2 years). Sperm were successfully retrieved across all age groups, and there was no upper male age limit above which sperm could not be retrieved. CONCLUSION(S): Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner <35 years old. Some older men with azoospermia may have secondary azoospermia with hypospermatogenesis, explaining the high sperm retrieval rate.
Authors: Parviz K Kavoussi; Brady T West; Shu-Hung Chen; Caitlin Hunn; Melissa S Gilkey; G Luke Machen; Keikhosrow M Kavoussi; Amy Esqueda; J David Wininger; Shahryar K Kavoussi Journal: Reprod Biol Endocrinol Date: 2020-08-26 Impact factor: 5.211