Presentation Authors: Annie Darves-Bornoz*, Nashville, TN, Joshua Halpern, James Wren, Matthew Fakhoury, Mehul Patel, Mary Kate Keeter, Nelson Bennett, Robert Brannigan, Chicago, IL
Introduction: Prior studies have examined sperm retrieval rates in men with non-obstructive azoospermia (NOA) secondary to specific etiologies (Y-chromosome and karyotype abnormalities). We compared sperm retrieval and testicular histopathology in non-idiopathic and idiopathic NOA.
Methods: Retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men were classified as idiopathic if they had no history of malignancy or cryptorchidism and routine genetic evaluation was negative. Demographic and clinical variables including age, preoperative testosterone (T), and follicle stimulating hormone (FSH) were abstracted. Multivariable regression was used to determine the association between idiopathic etiology and primary outcomes of sperm retrieval and spermatogenesis on histopathology.
Results: Among the total cohort (N=224), 86 (38.4%) were idiopathic, 75 (33.5%) non-idiopathic, and 63 (28.1%) did not undergo genetic evaluation. Non-idiopathic etiologies included cryptorchidism (N=15), malignancy (N=30), and genetic abnormality (N=28). Two additional patients had both cryptorchidism and malignancy. Median age (years) was higher among idiopathic (34, interquartile range [IQR] 31-39) versus non-idiopathic (32, IQR 29-35), p=0.004. Median serum T (ng/dL) was higher among idiopathic (365, IQR 307-477) versus non-idiopathic (343, IQR 240-421), p=0.02. Median FSH (IU) was lower among idiopathic (20.2, IQR 10.3-26.8) versus non-idiopathic (24.1, IQR 15.1-31.2), p=0.02. A higher proportion of idiopathic versus non-idiopathic men had a clinical varicocele (15.1% vs 5.3%, p=0.04)._x000D_
Sperm retrieval rates were similar between idiopathic and non-idiopathic NOA (41.8% vs 48.0%, p=0.4). Spermatogenesis was seen in a higher proportion of men with idiopathic versus non-idiopathic NOA, approaching but not reaching significance (31.4% vs 16.0%, p=0.07). On multivariable analysis, idiopathic etiology was not associated with sperm retrieval or spermatogenesis (p=0.27 and p=0.07).
Conclusions: Rates of sperm retrieval and spermatogenesis on testis pathology are similar in men with idiopathic and non-idiopathic NOA. These data may be useful to clinicians in pre-operative counseling for men with NOA and negative genetic evaluation.