Department of Urology, Taipei Veterans General Hospital, No 201, Section 2, Shipai Rd, Taipei, Taiwan.
Department of Physiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
J Assist Reprod Genet. 2022 Oct;39(10):2395-2401. doi: 10.1007/s10815-022-02601-1. Epub 2022 Sep 15.
To identify key predictors for successful sperm retrieval in men with AZFc microdeletion.
Totally, 71 infertile men with confirmed AZFc microdeletion were studied. For each patient, the endocrine profile including serum follicle stimulating hormone (FSH), luteinizing hormone, total testosterone, prolactin, and estradiol was recorded, along with intratesticular testosterone levels (ITT), age, and testicular size. The factors were further analyzed to determine the key predictors for successful sperm retrieval.
Of the 71 men with AZFc microdeletion, 52 (73.2%) were classified as having non-obstructive azoospermia (NOA), 7 (9.9%) as having cryptozoospermia, and 12 (15.8%) as having severe oligoasthenoteratozoospermia. Of the 52 men with azoospermia, 47 received microdissection testicular sperm retrieval, and sperm retrieval was successful in 35 of those cases (74.5%). A significantly lower serum FSH (p = 0.03) was found in those patients from whom sperm could be successfully retrieved. The area under the receiving operating characteristic curve for FSH was determined to be 0.721. Using an FSH cutoff point of 12.95 mIU/mL, the model for predicting successful sperm retrieval was found to have 51.4% sensitivity, 83.3% specificity, 90.0% positive predictive value, and 37.0% negative predictive value. ITT levels were obtained from 7 NOA patients, the mean ITT and the mean ITT/serum testosterone ratio was 1932.8 ng/ml and 567.2 in 6 men with successful sperm retrieval, whereas, in a patient with fail sperm retrieval, the levels were 2370 ng/ml and 393.0.
Men exhibiting AZFc microdeletion with discernible spermatogenesis from whom sperm was successfully retrieved by mTESE generally presented with relatively lower FSH levels.
确定 AZFc 微缺失男性精子成功获取的关键预测因素。
共研究了 71 例确诊 AZFc 微缺失的不育男性。对每位患者的内分泌谱（包括血清卵泡刺激素（FSH）、黄体生成素、总睾酮、催乳素和雌二醇）和睾丸内睾酮水平（ITT）、年龄和睾丸大小进行了记录。进一步分析这些因素以确定精子成功获取的关键预测因素。
在 71 例 AZFc 微缺失的男性中，52 例（73.2%）被归类为非阻塞性无精子症（NOA），7 例（9.9%）为隐匿性少精子症，12 例（15.8%）为严重少精子症。在 52 例无精子症男性中，47 例接受了显微镜睾丸精子获取术，其中 35 例（74.5%）获得了精子。成功获取精子的患者血清 FSH 水平明显较低（p=0.03）。FSH 的接收者操作特征曲线下面积被确定为 0.721。使用 FSH 截断值为 12.95 mIU/mL，预测精子成功获取的模型显示出 51.4%的敏感性、83.3%的特异性、90.0%的阳性预测值和 37.0%的阴性预测值。从 7 例 NOA 患者中获得了 ITT 水平，在 6 例成功获取精子的患者中，平均 ITT 和平均 ITT/血清睾酮比值分别为 1932.8ng/ml 和 567.2，而在 1 例精子获取失败的患者中，水平分别为 2370ng/ml 和 393.0。
通过 mTESE 成功获取精子的 AZFc 微缺失且具有明显生精功能的男性，其 FSH 水平通常较低。
