FSH levels and testicular volumes are associated with the severity of testicular histopathology in men with non-obstructive azoospermia

Parviz K Kavoussi,G Luke Machen,Maya Barsky,Shahryar K Kavoussi,Dan I Lebovic,Kayla Hudson

doi:10.1007/s10815-021-02313-y

Abstract

PurposeThe purpose of this study is to assess a potential association between FSH levels and testicular volumes with the severity of testicular histopathology on testicular biopsy in men with non-obstructive azoospermia (NOA) undergoing microdissection testicular sperm extraction (microTESE).MethodsA retrospective chart review was performed from the electronic health records of men who underwent microTESE with NOA.ResultsEighty-six men with NOA underwent microTESE with concomitant testicular biopsy for permanent section to assess the testicular cellular architecture. The histopathological patterns were categorized by severity indicating the odds of sperm retrieval into 2 categories. The unfavorable category included Sertoli cell only pattern and early maturation arrest (n = 50) and the favorable category included late maturation arrest and hypospermatogenesis patterns (n = 36). In the men with unfavorable histopathologic patterns, the mean FSH level was 22.9 ± 16.6 IU/L, and the mean testicular volume was 10.4 ± 6.0 cc. This was in comparison to men with favorable histopathologic patterns revealing a mean FSH level of FSH 13.3 ± 12.0 with a mean testicular volume of 13.3 ± 5.9 cc. There was a statistically significant higher FSH level in men with unfavorable histopathology than favorable (p = 0.004) as well as a significant smaller mean testicular volume in men with unfavorable histopathology (p = 0.029).ConclusionsHigher serum FSH levels and smaller testicular volumes are associated with more severe testicular histopathological patterns in men with NOA.

Highlights

One percent of men in the general population and 5–10% of men undergoing evaluation for infertility in the USA are azoospermic [1, 2]
The least severe histopathology seen in non-obstructive azoospermia (NOA) testicular biopsy samples is hypospermatogenesis, which reveals general depopulation of the seminiferous epithelium, but a variety of germ cells in all stages of spermatogenesis are visualized, with the seminiferous epithelium appearing atrophic with diminished luminal caliber
A number of studies have examined multiple clinical factors as predictors of microTESE sperm retrieval rates and few have evaluated predictors of fertilization, pregnancy, and live birth rates, this study aims to assess whether there is an association between follicle stimulating hormone (FSH) levels and testicular volumes with the severity of the testicular histopathology in men with NOA [9, 10, 12, 14,15,16,17,18,19,20,21,22,23,24,25]

Summary

Introduction

One percent of men in the general population and 5–10% of men undergoing evaluation for infertility in the USA are azoospermic [1, 2]. The combination of an elevated serum follicle stimulating hormone (FSH) level greater than 7.6 IU/L and smaller testicular volumes with a long axis of 4.6 cm or less predicts the etiology of azoospermia being due to spermatogenic dysfunction [7]. This has led to testis biopsy rarely being indicated in the diagnostic evaluation to differentiate between obstructive azoospermia and NOA. It is common practice for a testicular biopsy to be obtained for permanent section at the time of microTESE to help define the testicular histopathology and the severity of the testicular dysfunction.

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