Successful Repeat Microdissection Testicular Sperm Extraction in Men With Nonobstructive Azoospermia

PurposeWe studied factors that can predict successful repeat microdissection testicular sperm extraction in men with nonobstructive azoospermia.Materials and MethodsWe retrospectively analyzed the records of 126 men with nonobstructive azoospermia who underwent 1 successful microdissection testicular sperm extraction attempt. Clinical factors identifiable at the second procedure, including age, testicular volume, endocrinological data and histology, were analyzed.ResultsOverall testicular spermatozoa were successfully retrieved at 103 of 126 repeat attempts (82%). Men with a successful repeat attempt had lower follicle-stimulating hormone (mean ± SD 23.1 ± 12.4 vs 29.2 ± 12.8, p = 0.04) and larger testicular volume (mean 10 ± 5 vs 7 ± 4, p = 0.0001) at the repeat procedure compared to men with a failed repeat attempt. Adjusted associations from a multiple logistic regression model showed that no factors predicted sperm retrieval during repeat microdissection testicular sperm extraction. An ROC curve showed a fair prediction model (AUC = 0.71).ConclusionsThe follicle-stimulating hormone level and testicular volume at the repeat attempt appear to have predictive value to determine the success of a second attempt. These observations are interesting since testicular volume and follicle-stimulating hormone in men with nonobstructive azoospermia do not predict sperm retrieval at a primary microdissection testicular sperm extraction attempt.