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Impact factor:
2012

1,144
© Thomson Reuters, Journal Citation Reports, 2012

Indexed in:

Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, EMBASE/Excerpta Medica

SCImago Index

SCImago Journal & Country Rank
doi: 10.1016/j.acuroe.2012.06.008

Predictive factors of successful sperm retrieval in azoospermia

Factores predictivos de recuperación espermática en las azoospermias

C.R. Bonarriba a, , J.P. Burgués a, V. Vidaña a, X. Ruiz a, P. Pizá a

a Unidad de Reproducción Humana, Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, Spain

Keywords

Azoospermia. Predictive factors. Sperm retrieval. Follicle stimulating hormone (FSH). Inhibin B.

Palabras Clave

Azoospermia. Factores predictores. Recuperación espermática testicular. Hormona foliculoestimulante (FSH). Inhibina B.

Abstract

Introduction

Testicular sperm extraction with intracytoplasmic sperm injection is the standard treatment for azoospermia. The objective of this study is to identify predictive factors of successful sperm retrieval.

Materials and methods

Between June 2003 and May 2011, we tried testicular sperm extraction (TESE) in 74 azoospermic patients in the Reproductive Medicine Unit of Son Espases Hospital (Palma de Mallorca). Serum follicle stimulating hormone (FSH) and inhibin B levels, testicular histology, genetic study, presence or not of cryptozoospermia and testicular volume were examined.

Results

Spermatozoa were successfully recovered in 47.2% of the total patients, in 36% of non-obstructive azoospermic patients and in 100% of obstructive azoospermic patients. Low inhibin B and high FSH were correlated to sperm retrieval failure. The cutoff points were determined using ROC curves that were 67 pg/mL for inhibin B and 12.2 mUI/mL for FSH. Spermatozoa were not successfully retrieved in any patient with Y microdeletions in AZFa,b regions. Spermatozoa were successfully retrieved in 100% of the patients with CFTR mutations. The highest sperm retrieval rate was for hypospermatogenesis, followed by maturation arrest and Sertoli-cell-only. Spermatozoa were successfully retrieved in all cryptozoospermic patients. Although using a non-significant test, there seems to be a correlation between higher testicular volume and a higher probability of successful sperm retrieval.

Conclusions

Except for Y microdeletions in AZFa,b regions, there is no predictive factor of testicular sperm retrieval to rule out a patient for TESE. Lower inhibin B is more related to sperm retrieval failure than higher FSH. Sperm retrieval is possible for all cases of CFTR mutations but in any case of microdeletion Y in AZFa,b. The lack of germ cells is correlated with a high probability of sperm retrieval failure. The presence of cryptozoospermia is correlated with a high probability of sperm retrieval success. We do not find a statistically significant relation between testicular volume and successful sperm retrieval.

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