Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Abstract

Purpose

The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE).

Methods

We retrospectively evaluated 356 patients with non-obstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.

Results

The mean patients’ age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and −LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001)

Conclusions

This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.

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Correspondence to Ettore Caroppo.

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Conflict of interest

The authors declare that they have no competing interests.

Funding source

No funds were requested for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

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IRB approval was requested to the local ethical committee.

Additional information

Capsule

This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary figure 1
figure1

Testis histology of non-obstructive azoospermic patients undergoing TESE. A. Hypospermatogenesis, 20× magnification. Tubular sections with Sertoli cells and germinal cells in all maturative stages (spermatogonia, spermatocytes, and spermatids) but reduced in number. B. Hypospermatogenesis, 40× magnification. C. Late maturative arrest, 20× magnification Tubular sections with few germinal cells until spermatocitic stage, with only one mature spermatid. D. Late maturative arrest, 40× magnification. E. Sertoli cell only syndrome, 20× magnification. Tubular sections with Sertoli cell. No germinal cells are evident in all sections. F. Sertoli cell only syndrome, 40× magnification. (GIF 747 kb)

High resolution image (TIF 4179 kb)

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Caroppo, E., Colpi, E.M., Gazzano, G. et al. Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. J Assist Reprod Genet 34, 149–154 (2017). https://doi.org/10.1007/s10815-016-0812-3

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Keywords

  • Non-obstructive azoospermia
  • Testicular sperm extraction
  • Sperm retrieval
  • FSH
  • Testis histology
  • Testis volume