International Journal of Fertility and Sterility (Jul 2022)

Evaluation of Azoospermic Patients to Distinguish Obstructive from Non-Obstructive Azoospermia, and Necessity of Diagnostic Testis Biopsy: A Retrospective Study

  • Iman Shamohammadi,
  • Mohammadali Sadighi Gilani,
  • Seyed Mohammad Kazemeyni,
  • Tara Hasanzadeh,
  • Ahmad Vosough Taqi Dizaj,
  • Alireza Dizavi

DOI
https://doi.org/10.22074/ijfs.2021.532258.1140
Journal volume & issue
Vol. 16, no. 3
pp. 156 – 161

Abstract

Read online

Background: Accurate etiology of azoospermia is required for optimal management of patients. The aim of thisstudy was the determination of serum hormonal levels and testicular long axis cut off points to distinguish obstructiveazoospermia (OA) from non-OA (NOA) in Iranian patients as well as the evaluation of the necessity of diagnostictestis biopsy in azoospermic patients.Materials and Methods: In this retrospective study, data of 471 azoospermic patients such as history and physicalexamination, serum hormonal level, semen fluid parameter, and testicular long axis based on ultrasound wereevaluated from 2016 to 2020. All patients were examined by a single urologist and underwent a diagnostic testisbiopsy for a definite diagnosis. The diagnostic parameters were analyzed using Statistical Package for the SocialSciences (SPSS) version 16 with t test and chi-square test and receiver operating characteristic (ROC) curves todistinguish NOA from OA.Results: A total of 127 patients with OA and 284 with NOA were included in this study. The mean serum testosteronelevel was significantly higher in OA than NOA (4.2 vs. 3.4 ng/ml), whereas the mean serum follicular stimulating hormone(FSH, 5.3 vs. 19.1 mIU/ml) and luteinizing hormone (LH, 5.3 vs. 11 mIU/ml) were lower in OA. ROC curve analysisshowed that FSH and testicular long axis were the best diagnostic predictors. Using a combination of serum FSH (8.9mIU/ml) and testicular long axis (39 mm), the positive predictive value for NOA was 97.02% and for OA was 78.8%.Conclusion: Combination of serum FSH higher than 8.9 mIU/ml and testicular long axis lower than 39 mm werestrong predictors to distinguish NOA from OA in Iranian participants in this study. In addition, diagnostic testicularbiopsy seems to be necessary for patients with OA and NOA characteristics.

Keywords