Application of AMH in preoperative evaluation of micro-TESE in NOA patients
10.3760/cma.j.cn101441-20220715-00298
- VernacularTitle:AMH在NOA患者显微取精术前评估中的应用
- Author:
Jing ZHANG
1
;
Jianhui CHEN
1
;
Hong CHEN
1
;
Guihua SUN
1
;
Yida WANG
1
;
Guihua LIU
1
;
Lugang ZHAO
1
;
Cong FANG
1
;
Xiaoyan LIANG
1
Author Information
1. 中山大学附属第六医院生殖医学中心，广州 510655
- Publication Type:Journal Article
- Keywords:
Anti-Müllerian hormone;
Azoospermia;
Microdissection testicular sperm extraction
- From:
Chinese Journal of Reproduction and Contraception
2022;42(10):1008-1013
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the value of anti-Müllerian hormone (AMH) determination for estimating the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (micro-TESE) in non-obstructive azoospermia (NOA) patients.Methods:This was a retrospective case-control study. Totally 502 NOA patients treated with micro-TESE in Reproductive Medicine Research Centre, the Sixth Affiliated Hospital, Sun Yat-sen University from September 2014 to May 2022 were involved in the investigation. Patients were divided into different groups according to their surgery outcome and seminiferous tubules appearance. Age, testis volume, serum AMH, follicle-stimulating hormone (FSH), testosterone level were compared between the different groups. According to the cause of NOA, they were divided into orchitis group (idiopathic or parotid), AZFc gene deletion group, cryptorchidism descending fixation group, Klinefelter's syndrome (KS) group and idiopathic NOA group. The differences of SRR and AMH level in NOA patients with different etiologies were compared.Results:Testicular sperms were successfully retrieved in 270 cases (SRR=53.8%). There were no statistical differences in age, testicular volume, FSH and testosterone levels between the patients who succeeded or failed to obtain sperm (all P>0.05). The patients who obtained sperms had lower serum AMH level than those without sperm [0.81(0.16, 3.26) μg/L vs. 1.37(0.21, 4.84) μg/L, P<0.001]. Patients with orchitis or AZFc deletion, cryptorchidism, KS, idiopathic azoospermia have different AMH levels [(0.15(0.01,0.41) μg/L, 5.71(3.57,8.26) μg/L, 2.29(1.36,3.81) μg/L, 0.15(0.05,0.39) μg/L, 2.46(0.75,5.49) μg/L, P<0.001]. Idiopathic azoospermia patients who obtained sperms also had lower testosterone and AMH levels but higher age than those without sperm [(35.2±8.9) years vs. (32.5±5.5) years, P=0.010; (3.1±1.4) μg/L vs. (3.7±2.1) μg/L, P=0.029; 1.63(0.35,3.84) μg/L vs. 3.00(1.20,6.68) μg/L, P=0.001]. There were no statistical differences in testicular volume and FSH level between the two groups (all P>0.05). Receiver operating characteristic (ROC) curve showed that cut-off of serum AMH for successful sperm retrieval of idiopathic azoospermia patients was determined to be 2.96, with a sensitivity of 0.710 and specificity of 0.523, area under the curve (AUC) was 0.649. In the cases presenting heterogeneous seminiferous tubules during micro-TESE had lower AMH level and higher SRR than those presenting homogeneous seminiferous tubules [0.55(0.12, 2.05) μg/L vs. 2.99(0.76, 6.11) μg/L, P<0.001; 75.9% (236/311) vs. 17.8% (34/191), P<0.001]. Conclusion:NOA patients with low AMH level would have more opportunity to present heterogeneous seminiferous tubules when micro-TESE was performed and had higher SRR, especially in the idiopathic NOA cases.
