Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia.

Objective: To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA).
Design: A cohort study.
Setting: University-affiliated male reproductive health center.
Patient(s): A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history.
Intervention(s): Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation.
Main Outcome Measure(s): A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success.
Result(s): The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic.
Conclusion(s): This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair.
Clinical Trial Registration Number: NCT05110391.
Competing Interests: Declaration of Interests S.C.E reports receipt of lecture fees from Med.E.A. (Italy), Sanitanova (Italy), and Merck KGaA (Germany); unrestricted research grants from Merck KGaA, Germany; WHO (Switzerland) - Chair, Male Infertility Group, WHO Infertility Guidelines (in preparation) – unpaid; Brazilian Society of Urology (Brazil) - Member, Department of Education and Research – unpaid; Med.E.A. - Member, Andrology and Reproductive Medicine Committees - unpaid. A.P.P.A. reports funding from ANDROFERT (Brazil) - Institutional support: provision of study materials, funding for statistical analysis as part of a Thesis Project for the submitted work. R.M. has nothing to disclose. S.V. has nothing to disclose. A.F. has nothing to disclose. C.L.Z.R. has nothing to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)