Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia

Abstract

Objective: To determine the optimal cutoff value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods: We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cutoff value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results: Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cutoff value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions: The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.

Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

“…57 A retrospective study of 180 patients who NOA who underwent MD-TESE showed that the mean serum FSH level was significantly higher in the failure group than in the success group (p < 0.001), and a plasma FSH level > 14.6 mIU/mL predicted failure of sperm retrieval. 58 In contrast, in our study, we found that the mean serum FSH level was significantly higher in the success group than in the failure group (p = 0.001). 14 We also found that a plasma FSH level > 19.01 mIU/mL was the best cutoff value for predicting the SRR in patients with NOA.…”

Nomogram based on a circular RNA biomarker for predicting the likelihood of successful sperm retrieval via microdissection testicular sperm extraction in patients with idiopathic non-obstructive azoospermia

“…Consistent with our results, some preliminary studies of patients with NOA have reported no significant differences in TV or hormonal levels based on the success or failure of micro-TESE ( 32 , 33 ). Accordingly, serum hormone levels were not identified as a significant predictor of successful SRO ( 34 ). However, some studies have reported significantly higher levels of serum FSH in the failed group than in the successful group.…”

A Rare 46,X,t(Y;10)(q12;p14) Balanced Translocation in Non-Obstructive Azoospermic Patient with Elevated FSH and LH Levels

“…High levels of FSH and LH have been suggested as a contributing factor of abnormality in spermatogenesis, a cause of NOA, by multiple studies [5,[10][11][12]. Te study by Jahromi et al has even suggested FSH plasma levels above 14.6 mIU/mL as a failure predictor of micro-TESE in NOA patients [5], while another study associated elevated FSH and LH with failed sperm retrieval [13]. Elevated FSH/LH levels combined with other factors such as varicocele and chromosomal abnormalities are indicators of hypergonadotropic hypogonadism/eugonadism [12].…”

“…Tis can result in impaired sperm production. Te assessment of testicular function by the measurement of serum gonadotropins like FSH and LH is a method to identify and manage NOA [5].…”