Successful repeat microdissection testicular sperm extraction in men with nonobstructive azoospermia.

Overview

PURPOSE: We studied factors that can predict successful repeat microdissection testicular sperm extraction in men with nonobstructive azoospermia. MATERIALS AND METHODS: We retrospectively analyzed the records of 126 men with nonobstructive azoospermia who underwent 1 successful microdissection testicular sperm extraction attempt. Clinical factors identifiable at the second procedure, including age, testicular volume, endocrinological data and histology, were analyzed. RESULTS: Overall testicular spermatozoa were successfully retrieved at 103 of 126 repeat attempts (82%). Men with a successful repeat attempt had lower follicle-stimulating hormone (mean±SD 23.1±12.4 vs 29.2±12.8, p=0.04) and larger testicular volume (mean 10±5 vs 7±4, p=0.0001) at the repeat procedure compared to men with a failed repeat attempt. Adjusted associations from a multiple logistic regression model showed that no factors predicted sperm retrieval during repeat microdissection testicular sperm extraction. An ROC curve showed a fair prediction model (AUC=0.71). CONCLUSIONS: The follicle-stimulating hormone level and testicular volume at the repeat attempt appear to have predictive value to determine the success of a second attempt. These observations are interesting since testicular volume and follicle-stimulating hormone in men with nonobstructive azoospermia do not predict sperm retrieval at a primary microdissection testicular sperm extraction attempt.