2277 CLINICAL CHARACTERISTICS OF MEN WITH IDIOPATHIC NONOBSTRUCTIVE AZOOSPERMIA (2011)

You have accessJournal of UrologyInfertility: Therapy1 Apr 20112277 CLINICAL CHARACTERISTICS OF MEN WITH IDIOPATHIC NONOBSTRUCTIVE AZOOSPERMIA Peter Stahl, Jennifer Reifsnyder, Wayland Hsiao, and Peter Schlegel Peter StahlPeter Stahl New York, NY More articles by this author , Jennifer ReifsnyderJennifer Reifsnyder New York, NY More articles by this author , Wayland HsiaoWayland Hsiao New York, NY More articles by this author , and Peter SchlegelPeter Schlegel New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men without an identifiable cause for impaired sperm production comprise a large proportion of patients with nonobstructive azoospermia (NOA). We described the clinical characteristics of these patients, which have not previously been reported. METHODS A total of 1070 microdissection TESE (mTESE) attempts were done in 872 men with NOA from 1999–2010. NOA was labeled idiopathic for men with a 46XY karyotype, no Y chromosome microdeletions, and no history of cryptorchidism, gonadotoxin exposure, hypogonadotropic hypogonadism, orchitis, or significant testicular trauma. Clinical characteristics and mTESE outcome of patients with idiopathic NOA were compared to those with a known cause of azoospermia. A logistic regression model including age, FSH, histology, and testis volume was used to identify factors associated with sperm retrieval. RESULTS There were 276 patients with idiopathic NOA who underwent 350 mTESE attempts, comprising 31.7% of the patient population and 32.7% of mTESE procedures. Idiopathic patients had higher average testicular volumes, lower serum FSH levels, a lower prevalence of Sertoli cell only (SCO) histology, and a higher prevalence of maturation arrest (MA) (Table). Sperm were retrieved in 197/350 (56.3%) idiopathic cases and in 409/720 (56.8%) cases with a known cause of azoospermia (p=.90). No differences in fertilization rate (p=.09) or clinical pregnancy rate (p=.43) were observed. On multivarible regression, only FSH>30 (OR 2.45, p=.048) and histology (OR 2.24 for MA, p=.026; OR 95.88 for hypospermatogenesis, p<.0001) were significantly associated with sperm retrieval. For patients with both FSH>30 and non-SCO histology, sperm were retrieved 14/18 cases (77.8%). Table 1. Clinical characteristics of men with idiopathic and non-idiopathic NOA Characteristic Idiopathic (95% confidence interval) Known etiology of NOA (95% confidence interval) p-value Mean Age (years) 35.0(34.2-35.9) 35.0(34.4-35.7) 0.41# Mean FSH (IU/L) 19.9(18.4-21.4) 24.3(23.0-25.6) .0001# Mean Testis Volume (mL) 10.0(9.4-10.6) 8.7(8.3-9.2) .0007# Most Advanced Pattern of Histology SCO58.8% SCO70.9% .0037⁎ MA24.0% MA15.3% Hypospermatogenesis17.2% Hypospermatogenesis13.8% # Mann-Whitney Test ⁎ Chi-square test. CONCLUSIONS Nearly 1/3 of patients with NOA have no identifiable clinical or genetic etiology for their infertility. These patients have larger testicles and lower serum FSH values than non-idiopathic patients, which likely reflects the increased prevalence of MA in this population. However, the prognosis for sperm retrieval in idiopathic NOA is similar to that observed in NOA patients when the etiology of azoospermia is known, with the highest likelihood being for those who have FSH>30 and non-SCO histology. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e912-e913 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Stahl New York, NY More articles by this author Jennifer Reifsnyder New York, NY More articles by this author Wayland Hsiao New York, NY More articles by this author Peter Schlegel New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...