title: Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue.
abstract: 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.
authors.affiliation: Institute of Reproductive Medicine of the University, University of Münster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zitzmann
authors.forename: Verena
authors.initials: V
authors.lastname: Nordhoff
authors.forename: Victoria
authors.initials: V
authors.lastname: von Schönfeld
authors.forename: Annette
authors.initials: A
authors.lastname: Nordsiek-Mengede
authors.forename: Sabine
authors.initials: S
authors.lastname: Kliesch
authors.forename: Andreas N
authors.initials: AN
authors.lastname: Schüring
authors.forename: Craig Marc
authors.initials: CM
authors.lastname: Luetjens
authors.forename: Axel
authors.initials: A
authors.lastname: Kamischke
authors.forename: Trevor
authors.initials: T
authors.lastname: Cooper
authors.forename: Manuela
authors.initials: M
authors.lastname: Simoni
authors.forename: Eberhard
authors.initials: E
authors.lastname: Nieschlag
mesh_terms: 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
chemical_list: C422364:inhibin B; D007265:Inhibins; D005640:Follicle Stimulating Hormone