Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction

Capsule:
Sperm retrieval in men undergoing microdissection testicular sperm extraction (micro-TESE) was not negatively affected by age. Men 50 years old who underwent successful micro-TESE were more likely to have larger testes.

Authors:
Ranjith Ramasamy, M.D., Nikunj N. Trivedi, B.S., Jennifer E. Reifsnyder, M.D., Gianpiero D. Palermo, M.D., Ph.D., Zev Rosenwaks, M.D., Peter N. Schlegel, M.D.

Volume 101, Issue 3, Pages 653-655, March 2014

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

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

  • Jason Kovac

    An excellent study from the Cornell group. The abstract shown here is obviously truncated. The Results in the original abstract state “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". This data make sense in that older men are married to older women and the statistically significant differences in female age account for some of the clinical pregnancy rates.

  • Reassuring retrospective large single institution cohort study that men >50 years old can still consider genetic paternity via MicroTESE if they have NOA. However, these couples must be cautioned that their clinical pregnancy rates will be lower compared to men <50 years (25% vs. 48%) due to multiple factors, although their live birth rates are similar.

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