Effects of testicular volume, follicle stimulating hormone, luteinizing hormone and presence of varicocele on successful sperm retrieval in non-obstructive azoospermia

INTRODUCTION: The aim of the study was to evaluate the relation between the probability of positive sperm extraction with Testicular Sperm Extraction(TESE) and the clinical, laboratory and demographic features in a series of non-obstructive azoospermia(NOA) infertility patients who consulted to Gazi University School of Medicine, Urology Department in order to determine and inform couples who could not succeed and thus avoid unnecessary treatment.
METHODS: Sixty-four patients with non-obstructive azoospermia were enrolled to the study. Demographical features and previous varicocele operation history were noted. In all cases serum levels of Follicle Stimulating Hormone(FSH), Luteinizing Hormone(LH), genetic analysis and bilateral testicular volume were determined to find the correlation between probability of positive sperm extraction with TESE.
RESULTS: The incidence of NOA among all infertile men was 15.1%. TESE success rate in NOA was 29,6%. There were significant differences in FSH levels(p<0,001), LH levels(p=0,006), right testicular volume(p<0,001), and left testicular volume(p<0,001). The results were evaluated by ROC analysis. Success rate of TESE was decreased when FSH>8,9mIU/ml(sensitivity80%, specifity68%), LH>4,25mIU/ml(sensitivity76%, specifity53%), right testicular volume<8,5ml(sensitivity84%, specifity56%) and left testicular volume<7,25ml(sensitivity84%, specifity56%) in NOA. As there was no paramater with one hundred percent sensitivity, probability of positive sperm retrieval would stil exist in these patients.
DISCUSSION AND CONCLUSION: In NOA cases increased FSH and LH levels, decreased testis volumes have negative effect at sperm retrieval. Chromosomal damages like Klinefelter Syndrome also decrease success rate. Determining groups with poor prognosis, may help prevention of patients from unnecessary processes, risks and costs.