Evaluating the Outcome of Conventional Tese from Clinical Presentation in Patients with Non-Obstructive Azoospermia

Context: Several etiologies have been identified and some clinical factors might predict the probability of finding sperm in nonobstructive azoospermia (NOA). Aims: Find and correlate the clinical findings to the success of testicular sperm extraction (TESE). Settings and Design: Retrospective review of patients with NOA undergoing TESE in our department between 2012 and 2015. Methods and Material: We analyzed the sperm retrieval rate (SRR) based on testicular size, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), total testosterone and prolactin levels as well as on the karyotype findings. We also report the results of ICSI based on clinical features. Statistical analysis used: Mann-Whitney U test; chi-square test; receiving operating characteristic and area under the curve; binary logistic regression. Results: 54 patients, mean age of 34, 57 years. The overall SRR was 51, 9%. Difference between negative and positive SRR regarding mean FSH (p=0,002) and mean LH (p=0,007) was found. No difference in SRR based on karyotype findings (p=0.127) or testicular size (p=0,336) was identified. A multivariate binary regression concluded that only FSH could be used as a predictor for TESE+. A FSH value <11,0UI/L was associated with an OR of 19 for TESE+ result (95% CI 4.1-87.6). With FSH <11,0UI/L the probability of TESE+ increases to 85% and if FSH>11,0UI/L the probability of TESE+ will be 24%. 28 patients proceeded to ICSI with clinical pregnancy and live birth rates of 20,7% and 17,2%. Conclusions: NOA patients should be fully assessed and informed about the probability of TESE+; FSH levels alone might be useful to do that. Furthermore those with normal FSH and normal testicular size can expect higher rates of sperm retrieval and live birth after ICSI.