Human Reproduction, Vol 12, 80-86, Copyright © 1997 by Oxford University Press
H Tournaye, G Verheyen, P Nagy, F Ubaldi, A Goossens, S Silber, AC Van Steirteghem and P Devroey
Recovery of testicular spermatozoa from azoospermic patients with
testicular failure followed by intracytoplasmic sperm injection (ICSI) is a
recent advance in the treatment of male infertility. This study aimed at
investigating which parameter(s) may predict successful testicular sperm
recovery. We reviewed 395 testicular sperm recovery procedures and analysed
the most frequently available parameters for clinical decision-making in
azoospermic patients: (i) presence of at least one single spermatozoon in
at least one preliminary semen analysis; (ii) maximum testicular volume;
(iii) serum follicle stimulating hormone (FSH); and (iv) presence of
spermatozoa in the histology of a randomly-taken testicular biopsy.
Sensitivity, specificity, positive and negative predictive value, positive
and negative likelihood ratio and accuracy were calculated for the above
index parameters in different clinically relevant subgroups using receiver
operating characteristic (ROC) curves whenever possible. Spermatozoa were
always successfully recovered in patients with normal testicular
histological findings (n = 173) or hypospermatogenesis (n = 16) but not in
some patients with tubular sclerosis (seven out of 18), Sertoli cell-only
pattern (55 out of 112) or maturation arrest (39 out of 76). Histopathology
was the best test for predicting successful sperm recovery in the whole
population (sensitivity: 86%, specificity: 93%, accuracy: 0.87). In
patients with secretory azoospermia, histopathology was again the most
accurate parameter (accuracy: 0.74), especially in patients showing Sertoli
cell-only pattern (accuracy: 0.83) but not in patients showing maturation
arrest (accuracy: 0.55). In patients with serum FSH concentrations > 12
IU/l and maximum testicular volume < 15 ml, histopathology was not found
to be accurate. Semen analysis, maximum testicular volume and serum FSH
were not highly predictive in all subgroups studied. Our analysis shows
that no strong predictors for successful testicular sperm recovery are
available except for testicular histopathology.
ARTICLES
Are there any predictive factors for successful testicular sperm recovery in azoospermic patients?
Centre For Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University.
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