Percutaneous Epididymal Sperm Aspiration for Men With Obstructive Azoospermia: Predictors of Successful Sperm Retrieval

ObjectiveTo evaluate the predictors of successful sperm retrieval using percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia (OA).Materials and MethodsData were collected retrospectively from 255 patients with OA who underwent PESA between March 2007 and September 2012. Sperm retrieval outcomes were reported as motile sperm (>1% motile), rare motile sperm (≤1% motile), nonmotile sperm, and no sperm found. Variables included in our analysis were patient age, testicular volume, and diagnosis (congenital bilateral absence of the vas deferens, vasectomy, failed vasovasostomy, or other). Multivariate logistic regression models were constructed to detect variables prognostic for successful PESA outcomes.ResultsAfter PESA, motile sperm were detected in 192 patients (75.3%), rare motile sperm in 24 (9.4%), nonmotile sperm in 27 (10.6%), and no sperm in 12 (4.7%). There was no difference among the groups in terms of median testicular volume or diagnosis. However, there was a significantly higher median age (P = .0234) in men who had no sperm (45 years) or nonmotile sperm (46 years) compared with those who had motile (41 years) or rare motile sperm (40 years). On multivariate analysis, larger testicular volume was independently prognostic for improved motile sperm retrieval rates (P = .0056) whereas increased paternal age strongly trended toward lower rates (P = .0589).ConclusionThe data suggest that PESA yields good motile sperm retrieval rates in patients with OA. Younger paternal age and larger testicular volume appear to be predictive of higher motile sperm retrieval rates.