Evaluation of testicular volume and hormonal parameters in the prediction of testicular sperm extraction outcome in patients with nonobstructive azoospermia

ObjectiveIn men with obstructive azoospermia, the chance of successful retrieval of sperm approaches more than 90%, whereas the chances of sperm retrieval in men with nonobstructive azoospermia (NOA) are not as high. The objective of this study was to evaluate some preoperative factors to predict successful sperm retrieval with testicular sperm extraction. Patients and methodsWe evaluated 82 infertile men with NOA. Factors including age, infertility period, surgical history, testicular volume, serum follicle-stimulating hormone (FSH), serum inhibin B, serum luteinizing hormone (LH), and serum total testosterone were assessed in relation to sperm retrieval results. The predictive values of total testicular volume, LH, FSH, and inhibin B for discriminating between successful and unsuccessful testicular sperm extraction were assessed by calculating the corresponding area under the receiver operating characteristic curve. ResultsSperm retrieval was successful in 41 (50%) biopsies. Men with a higher mean testicular volume, a higher serum inhibin B, lower LH, and a lower FSH had successful sperm retrieval. The cutoff points for successful sperm retrieval, using receiver operating characteristic curves, were as follows: 9.5 ml for testicular volume, 12.47 IU/l for serum FSH, 36.33 pg/ml for serum inhibin B, and 6.64 IU/l for LH. Combining inhibin B+FSH+LH had the highest area under the receiver operating characteristic curve (0.954), whereas combining FSH and inhibin B serum levels showed the highest sensitivity (97.56). ConclusionCombinations including serum LH, inhibin B, and FSH levels give the best predictive value for successful sperm retrieval, compared with each alone, in patients with NOA.