Predictive factors of c-TESE success in eastern algerian patients with non-obstructive azoospermia: role of histology, hormones, and testicular volume.

Abstract

BACKGROUND: Non-obstructive azoospermia is the most severe and common form, representing 10–15% of infertile men. For these patients, testicular sperm extraction followed by intracytoplasmic sperm injection offer the only viable fertility option. However, sperm retrieval rates in non-obstructive azoospermia remain significantly lower than in obstructive azoospermia. Optimizing testicular sperm extraction outcomes in non-obstructive azoospermia requires understanding the clinical, hormonal, genetic, and histological factors that influence sperm retrieval. The present study aims to evaluate the impact of key clinical and biological factors on sperm retrieval out comes in patients with non-obstructive azoospermia from eastern Algeria, with the goal of improving retrieval rates and identifying reliable predictive factors for successful sperm recovery. RESULT: Sperm retrieval was successful in 38.3% of patients with non-obstructive azoospermia. Testicular histology had a significant impact on retrieval outcomes (p < 0.001). The highest sperm retrieval rates were observed in patients with late maturation arrest and hypospermatogenesis. In contrast, severe histological patterns, particularly testicular fibrosis and Sertolicell-only syndrome, were strongly associated with sperm retrieval failure, with odds ratios of 0.024 and 0.020, respectively. Serum follicle-stimulating hormone and luteinizing hormone levels were significantly correlated with sperm retrieval success (p = 0.004 and p = 0.05, respectively). Logistic regression analysis showed an odds ratio of 0.947 for FSH, with a cut-off value of 8.83 mIU/mL, indicating that lower FSH levels were associated with higher retrieval success. For LH, the odds ratio was 1.069, with a cut-off value of 5.75 mIU/mL. CONCLUSION: Overall, testicular histology, serum follicle-stimulating hormone levels, and testicular volume emerged as the most important independent predictors of sperm retrieval success in Algerian patients with non-obstructive azoospermia undergoing testicular sperm extraction. Luteinizing hormone was identified as a weaker predictive factor compared with FSH and testicular volume. Although, histological evaluation is obtained post-biopsy, it remains clinically valuable by guiding personalized patient management, including the selection of the most appropriate sperm retrieval technique, the initiation of hormonal therapy, and the prediction of outcomes in subsequent retrieval attempts.