Testicular volume is a noninvasive predictor of sperm retrieval failure in idiopathic nonobstructive azoospermia

We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia(iNOA).We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction.The Chi-square test and Mann–Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons.A logistic regression analysis was conducted to identify predictors of retrieval failure.Area under the receiver operating characteristic curve for each variable was evaluated,and the net clinical benefit was calculated using a clinical decision curve.Patients with iNOA had a lower sperm retrieval rate than those with known causes.Moreover,testicular volume was an independent factor affecting sperm extraction outcomes(odds ratio=0.79,P<0.05).The testicular volume cut-off value was 6.5 ml(area under the curve:0.694).The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed.The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution.There was also a significant association between a uniform tubule distribution and testicular volume.In conclusion,a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.

Association between anti-Müllerian hormone concentrations and sperm retrieval outcomes in patients with idiopathic nonobstructive azoospermia:a systematic review and meta-analysis

Microdissection testicular sperm extraction(mTESE)is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia(iNOA).However,the success rate of sperm retrieval varies among individuals.We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA.We searched PubMed,EMBASE,and Web of Science from database inception to August 2,2023.The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE.Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models.The overall sperm retrieval rate was 36.8%(95%confidence interval[CI]:27.5%-46.0%,I 2=95.0%)in nine studies comprising 1892 patients with iNOA.No significant differences were found in age,testicular volume,serum total testosterone concentrations,or inhibin B concentrations between positive and negative sperm retrieval outcomes.Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE(weighted mean differences:−2.70;95%CI:−3.94-−1.46,I 2=79.0%).In conclusion,this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA,while age,testicular volume,total testosterone,and inhibin B show no significant association.These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.

Factors affecting patency time and semen quality in a single-armed microsurgical vasoepididymostomy

Although microsurgical vasoepididymostomy(MVE)is an effective treatment for epididymal obstructive azoospermia,some patients may experience delayed patency or suboptimal semen parameters after patency.However,research into patency time,semen quality postpatency,and associated influencing factors remains limited.This study aimed to address these issues by evaluating 181 patients who underwent at least one-sided MVE employing asingle-armed longitudinal intussusception vasoepididymostomy technique,with a follow-up period of over 12 months for 150 patients.The overall patency rate was 75.3%,with 86.0%of patients achieving patency within 6 months following MVE.Unexpectedly,factors such as age,history of epididymitis,duration of surgery,side of anastomosis,sperm motility in epididymal fluid,and the site of anastomosis showed no correlation with patency time.Nonetheless,our univariate and multivariate linear regression analysis indicated that only the site of anastomosis was positively correlated with and could independently predict postoperative total motile sperm count.Therefore,the site of anastomosis might serve as a predictor for optimal postoperative semen quality following the MVE procedure.

Novel mutations in LRRC23 cause asthenozoospermia in a nonconsanguineous family

The cause of asthenozoospermia(AZS)is not well understood because of its complexity and heterogeneity.Although some gene mutations have been identified as contributing factors,they are only responsible for a small number of cases.Radial spokes(RSs)are critical for adenosine triphosphate-driven flagellar beating and axoneme stability,which is essential for flagellum motility.In this study,we found novel compound heterozygous mutations in leucine-rich repeat-containing protein 23(LRRC23;c.1018C>T:p.Q340X and c.881_897 Del:p.R295Gfs*32)in a proband from a nonconsanguineous family with AZS and male infertility.Diff-Quik staining and scanning electron microscopy revealed no abnormal sperm morphology.Western blotting and immunofluorescence staining showed that these mutations suppressed LRRC23 expression in sperm flagella.Additionally,transmission electron microscopy showed the absence of RS3 in sperm flagella,which disrupts stability of the radial spoke complex and impairs motility.Following in vitro fertilization and embryo transfer,the proband’s spouse achieved successful pregnancy and delivered a healthy baby.In conclusion,our study indicates that two novel mutations in LRRC23 are associated with AZS,but successful fertility outcomes can be achieved by in vitro fertilization-embryo transfer techniques.