CORRELATION OF TESTICULAR SPERM EXTRACTION WITH MORPHOLOGICAL, BIOPHYSICAL AND ENDOCRINE PROFILES IN MEN WITH AZOOSPERMIA DUE TO PRIMARY GONADAL FAILURE

To identify the predictive factors for testicular sperm extraction (TE SE) and to understand the pathology associated with TESE, we carried o ut a prospective study in 40 consecutive men with azoospermia due to p rimary gonadal failure. The main outcome measure was the retrieval of at least one testicular spermatozoon. Endocrine and biophysical profil es, testicular histology, Johnsen score and testicular spermatids were used as predictor of sperm extraction. Spermatogenesis was quantified with the Johnsen score. A variable pattern of spermatogenesis was com mon, being present in 20 (50%) patients. Visualisation of testicular s permatids on testicular histology showed a strong association with TES E (P < 0.0001). Statistically significant differences were detected in plasma follicle stimulating hormone (FSH) and testicular volume betwe en patients who had hypospermatogenesis and Sertoli cell-only or matur ation arrest. There were no significant differences in Johnsen score, biophysical and endocrine profiles between the groups with successful and failed TESE. However, a statistically significant trend occurred w ith changes in histological pattern [chi(2) for trend, P = 0.001; Pear son's coefficient (r) = 0.6], Johnsen score (P = 0.022; r = 0.5), test icular volume (P = 0.01; r = 0.5) and plasma FSH concentration (P = 0. 044; r = 0.4), albeit to a limited degree. Differences in the interpre tation of histological patterns with different assessors was observed. The type of occupation or risk factors for axoospermia showed no asso ciation with testicular pathology or TESE. Variable histological patte rns in different tubules in the same individual may explain the poor c orrelation of TESE with endocrine and biophysical profiles, Johnsen sc ore and histological pattern. Differences in the amount of tissue used for TESE and histopathology, and misinterpretation of testicular hist ology rather than failure to quantify spermatogenesis may explain the poor correlation between histological patterns and TESE. Testicular sp ermatids predicted TESE. However, considerable overlap in values means that no single variable can provide a perfect discrimination between the groups with successful and failed TESE.