Evaluation of Azoospermic Patients to Distinguish Obstructive from Non-Obstructive Azoospermia, and Necessity of Diagnostic Testis Biopsy: A Retrospective Study

Abstract

Accurate etiology of azoospermia is required for optimal management of patients. The aim of this<br />study was the determination of serum hormonal levels and testicular long axis cut off points to distinguish obstructive<br />azoospermia (OA) from non-OA (NOA) in Iranian patients as well as the evaluation of the necessity of diagnostic<br />testis biopsy in azoospermic patients.<br />Materials and Methods: In this retrospective study, data of 471 azoospermic patients such as history and physical<br />examination, serum hormonal level, semen fluid parameter, and testicular long axis based on ultrasound were<br />evaluated from 2016 to 2020. All patients were examined by a single urologist and underwent a diagnostic testis<br />biopsy for a definite diagnosis. The diagnostic parameters were analyzed using Statistical Package for the Social<br />Sciences (SPSS) version 16 with t test and chi-square test and receiver operating characteristic (ROC) curves to<br />distinguish NOA from OA.<br />Results: A total of 127 patients with OA and 284 with NOA were included in this study. The mean serum testosterone<br />level was significantly higher in OA than NOA (4.2 vs. 3.4 ng/ml), whereas the mean serum follicular stimulating hormone<br />(FSH, 5.3 vs. 19.1 mIU/ml) and luteinizing hormone (LH, 5.3 vs. 11 mIU/ml) were lower in OA. ROC curve analysis<br />showed that FSH and testicular long axis were the best diagnostic predictors. Using a combination of serum FSH (8.9<br />mIU/ml) and testicular long axis (39 mm), the positive predictive value for NOA was 97.02% and for OA was 78.8%.<br />Conclusion: Combination of serum FSH higher than 8.9 mIU/ml and testicular long axis lower than 39 mm were<br />strong predictors to distinguish NOA from OA in Iranian participants in this study. In addition, diagnostic testicular<br />biopsy seems to be necessary for patients with OA and NOA characteristics.

Keywords: Biopsy; Nonobstructive azoospermia; obstructive Azoospermia.

Fig 1

ROC curve for serum hormonal level and testicular long axis. Testis length (0.85), FSH (0.92), LH (0.81), and testosterone (0.65). ROC; Receiver operating characteristic, FSH; Follicular stimulating hormone, and LH; Luteinizing hormone.

Fig 2

Photomicrographs pathological reports of testis biopsy. A. Normal spermatogenesis, B. Hypo spermatogenesis, C. Maturation arrest, D. Sertoli cell only syndrome, E. Lydig cell hyperplasia, and F. Mixed pattern (scale bar: 20 µm).