Percutaneous epididymal sperm aspiration: a diagnostic tool for the prediction of complete spermatogenesis

Abstract

The classification of azoospermia into obstructive or non-obstructive is largely based on medical history, physical examination and biochemical markers in serum and semen. However, the most accurate parameter for diagnosis is the testicular histology. The predictive value of the percutaneous epididymal sperm aspiration (PESA), FSH, LH, testosterone, inhibin-B and testicular volume was investigated for their accuracy to predict a complete spermatogenesis (Johnsen score > or =8) in order to replace the testicular histology. The specificity and sensitivity of FSH, inhibin-B, LH, testosterone, testicular volume, and the presence of sperm in a PESA procedure was evaluated in 147 azoospermic males attending the centre for infertility diagnosis. A positive PESA outcome presented the highest sensitivity and specificity to predict a Johnsen score > or =8 (93 and 94% respectively) compared with FSH (90 and 19%), inhibin-B (88 and 57%) and testicular volume (95 and 45%). Differences in clinical presentation were observed between patients with positive sperm retrieval with PESA, depending on the aetiology of obstruction. In conclusion, the presence of spermatozoa in the epididymis (PESA+) correlates with a Johnsen score > or =8 and is the most accurate parameter to predict complete spermatogenesis compared with clinical or biochemical parameters. Between obstructive azoospermic patients, the clinical parameters observed varied according to the aetiology.

Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia?

“…Our data show that in patients with suspected primary OA, inhibin-B values cannot predict the outcome of MESA. These results are in contrast to an observation by Ramos et al [27] who concludes that inhibin-B has significant prognostic value to find sperm at PESA. It should be noted, however, that the discrepancy between the present study results and this study, might, in part, be explained by the selection of patients in the present study.…”

Pregnancy and birth after intracytoplasmic sperm injection with normal testicular spermatozoa in a patient with azoospermia and tail stump epididymal sperm

“…In such cases, a distinction should be made between obstructive and non-obstructive azoospermia. When normal genitalia (testes, epididymis and vasa deferentia) and endocrine profile are found in a normal virilized adult male, the finding of spermatozoa within the epididymis is highly indicative of obstructive azoospermia ( 12 ), as shown in our patient. Obstruction in the male reproductive system can be congenital or acquired.…”

Reproductive Potential of Men with Obstructive Azoospermia Undergoing Percutaneous Sperm Retrieval and Intracytoplasmic Sperm Injection According to the Cause of Obstruction

“…25 Moreover, the presence of spermatozoa at epididymal retrieval yields 93% sensitivity and 94% specificity to predict normal spermatogenesis. 26 Our study depended primarily on percutaneous methods of SR, which yielded a high SSR for all etiology categories and showed only minor complications. Success rates were calculated based on the finding of motile sperm.…”