Seminal Immature Germ Cells As a Predictor of Microdissection Testicular Sperm Extraction for Development of a Combined Predictive Model.

Purpose: To investigate the relationship between immature spermatogenic cells (IGC) in semen and sperm retrieval (SR) rate of microdissection testicular sperm extraction (m-TESE) in patients with non-obstructive azoospermia (NOA).

Materials and methods: 95 patients with NOA who underwent m-TESE between 2019 and 2024 were included. These patients underwent comprehensive clinical, laboratory, and histopathological evaluations. Multivariable logistic regression analysis was used to explore the association between several variables and m-TESE success rate in patients with NOA, and a predictive model was developed. Model validity and stability were assessed through five-fold cross-validation.

Results: A positive SR was observed in 40.0% of patients undergoing m-TESE. Multivariate logistic regression analysis identified mean testicular volume (TV) (p=0.023, odds ratio [OR]=1.382, 95% confidence interval [CI]=1.046-1.826, area under the ROC curve [AUC]=0.681), IGC in semen (p<0.001, OR=13.757, 95% CI=3.663-51.671, AUC=0.785), and Johnsen score (p=0.005, OR=2.642, 95% CI=1.339-5.213, AUC=0.707) as significant predictors of positive SR, with IGC demonstrating the strongest predictive value. Four predictive models were constructed using the three factors: models A (Mean TV+Johnsen score, AUC=0.726±0.039), B (Mean TV+IGC, AUC=0.859±0.021), C (Johnsen score+IGC, AUC=0.864±0.029), and D (Mean TV, Johnsen score+IGC, AUC=0.874±0.028). Models showed significant improvements in predictive performance. The validity and stability of models B, C, and D containing IGC were better than those of model A without IGC (p<0.05).

Conclusion: The presence of IGC in the semen of patients with NOA may serve as a predictive factor for successful SR using m-TESE. Models incorporating IGC significantly enhanced stability and validity, highlighting their potential clinical utility.