Correlation of testicular sperm extraction with morphological, biophysical and endocrine profiles in men with azoospermia due to primary gonadal failure

To identify the predictive factors for testicular sperm extraction (TESE)and to understand the pathology associated with TESE, we carried out aprospective study in 40 consecutive men with azoospermia due to primarygonadal failure. The main outcome measure was the retrieval of at least onetesticular spermatozoon. Endocrine and biophysical profiles, testicularhistology, Johnsen score and testicular spermatids were used as predictorsof sperm extraction. Spermatogenesis was quantified with the Johnsen score.A variable pattern of spermatogenesis was common, being present in 20 (50%)patients. Visualisation of testicular spermatids on testicular histologyshowed a strong association with TESE (P < 0.0001). Statisticallysignificant differences were detected in plasma follicle stimulatinghormone (FSH) and testicular volume between patients who hadhypospermatogenesis and Sertoli cell-only or maturation arrest. There wereno significant differences in Johnsen score, biophysical and endocrineprofiles between the groups with successful and failed TESE. However, astatistically significant trend occurred with changes in histologicalpattern [chi2 for trend, P = 0.001; Pearson's coefficient (r) = 0.6],Johnsen score (P = 0.022; r = 0.5), testicular volume (P = 0.01; r = 0.5)and plasma FSH concentrations (P = 0.044; r = 0.4), albeit to a limiteddegree. Difference in the interpretation of histological patterns withdifferent assessors was observed. The type of occupation or risk factorsfor azoospermia showed no association with testicular pathology or TESE.Variable histological patterns in different tubules in the same individualmay explain the poor correlation of TESE with endocrine and biophysicalprofiles, Johnsen score and histological pattern. Differences in the amountof tissue used for TESE and histopathology, and misinterpretation oftesticular histology rather than failure to quantify spermatogenesis mayexplain the poor correlation between histological patterns and TESE.Testicular spermatids predicted TESE. However, considerable overlap invalues means that no single variable can provide a perfect discriminationbetween the groups with successful and failed TESE.