Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue.
OBJECTIVE
To assess individual chances for a live-born child in azoospermic men by performance of testicular sperm extraction (TESE) followed by intracytoplasmatic sperm injection (ICSI).


METHODS
A retrospective cohort study.


METHODS
An academic fertility care center and research unit.


METHODS
Two hundred three couples who wished to have a child; all men had azoospermia.


METHODS
All men were operated for TESE; 112 men were found to have elongated spermatids (ES), and 209 ICSI cycles were performed in these men using cryopreserved tissue.


METHODS
Predictors for the chances to obtain live sperm and for probabilities of fertilization, clinical pregnancies, and live births.


RESULTS
Testicular volume, FSH, and inhibin B levels were predictors for the presence of ES. Intracytoplasmic sperm injection resulted in 23 pregnancies, leading to 20 live births. Despite the presence of ES and performance of ICSI in cases of FSH levels >or=20 IU/L, no pregnancy resulted in these men (n = 21). Receiver operating characteristics revealed FSH levels of >or=20 IU/L as cutoff for treatment success. The number of testicular tubuli containing ES served as a predictor for clinical pregnancy as well as for live birth. Cigarette smoking by the male partner exerted a significant negative influence on treatment success.


CONCLUSIONS
The degree of completely maintained spermatogenesis within the biopsy appears to reflect intrinsic abilities of spermatozoa to induce normal embryo development. Charts based on regression models are presented for counseling patients before TESE; these explain chances of finding ES and probability of successful ICSI. Obtaining offspring is unlikely in cases of azoospermia and of FSH levels of >or=20 IU/L.
Zitzmann
Michael
M
Institute of Reproductive Medicine of the University, University of Münster, Münster, Germany.
Nordhoff
Verena
V
von Schönfeld
Victoria
V
Nordsiek-Mengede
Annette
A
Kliesch
Sabine
S
Schüring
Andreas N
AN
Luetjens
Craig Marc
CM
Kamischke
Axel
A
Cooper
Trevor
T
Simoni
Manuela
M
Nieschlag
Eberhard
E
D000328:Adult; D015331:Cohort Studies; D015925:Cryopreservation; D005220:Fathers; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007265:Inhibins / Q000097:blood; D050498:Live Birth; D008297:Male; D008875:Middle Aged; D009845:Oligospermia / Q000097:blood* / Q000473:pathology; D009929:Organ Size; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013087:Spermatids / Q000648:ultrastructure*; D013737:Testis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting
C422364:inhibin B; D007265:Inhibins; D005640:Follicle Stimulating Hormone