Predictive factors of successful micro-dissection testicular sperm extraction for patients with non obstructive azoospermia

Abstract

Abstract Background Male infertility contributes to nearly half of all infertility cases among couples, and azoospermia accounts for about 10–15% of these. Non-obstructive azoospermia (NOA) results from testicular failure to produce sperm rather than physical obstruction. Micro-dissection testicular sperm extraction (micro-TESE) is currently the most effective technique for sperm retrieval in NOA, yet its outcome remains variable. Identifying reliable predictive factors could improve patient counseling, optimize selection, and reduce treatment costs. Objective To identify clinical, hormonal, and histopathological predictors associated with successful micro-TESE outcomes in men with NOA. Methods A prospective study was conducted on 600 men with NOA at Qena University Hospital (May 2022 – May 2024). All patients underwent detailed clinical assessment, hormonal evaluation, scrotal ultrasonography, and micro-TESE under an operating microscope. Variables analyzed included age, testicular volume, hormone profile (FSH, LH, testosterone, estradiol, prolactin), Outcomes were compared between successful and failed micro-TESE procedures. Statistical analyses employed Mann–Whitney U (MWU), chi-square (χ2), Fisher’s exact (f) tests, logistic regression, and receiver-operating-characteristic (ROC) curves. Results Successful sperm retrieval occurred in 62.7% (376/600) of patients. Predictors of success included larger testicular volume, prior infertility treatment, lower FSH, LH, estradiol, and prolactin levels, and higher testosterone levels (all p < 0.05). Multivariate regression analysis identified hormonal profile and testicular volume as significant predictors. ROC analysis showed excellent performance for testosterone > 4.8 ng/mL (AUC = 0.94, 90.6% sensitivity) and Johnsen score > 1.5 (AUC = 0.98, 97.2% sensitivity). Conclusion Hormonal profile, testicular size, prior treatment, and histopathology significantly influence micro-TESE outcomes in NOA. Incorporating these parameters into pre-operative evaluation may improve patient selection and success rates.