title: A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study.
abstract: BACKGROUND
  In non-obstructive azoospermia (NOA), testicular sperm extraction (TESE) is successful in ≈ 50% of cases. A parameter for predicting TESE quality and pregnancy rates after ICSI of testicular spermatozoa is still lacking.
  
  
  METHODS
  We retrospectively evaluated the total testicular volume (TTV), hormone levels and TESE quality in 280 patients with NOA. After successful TESE, the characteristics of the ICSI cycles and the take-home baby rates were evaluated.
  
  
  RESULTS
  TESE was successful in 149 patients (53.2%). In a multivariate logistic regression analysis, only TTV, FSH and inhibin B were correlated with the TESE outcome. A score including these three parameters was the best predictor of successful TESE (positive likelihood ratio: +3.01). When the score was <18.5, TESE was successful in 77.4% of cases and 'sperm rich' (i.e. yielding >100 spermatozoa) in 91.1% of cases; 42.8% of couples took a baby home. The take-home baby rate did not depend on whether the score was <18.5 or between 18.5 and 3700. If the score was >3700, TESE was successful in 37.8% of cases and 'sperm rich' in 14.3% of cases; only one couple took a baby home (a rate of 7.7 versus 42.8% when the score was <18.5; P< 0.001). Owing to low sperm retrieval on the day of oocyte retrieval, fewer oocytes were injected when the score was >3700 than when <3700.
  
  
  CONCLUSIONS
  Thanks to better knowledge of TESE quality, the present score could help to improve care and pre-ICSI counseling for patients with NOA.
authors.affiliation: Department of Reproductive Biology and CECOS, Lille University Medical Center, Lille 59000, France. florenceboitrelle@yahoo.fr
authors.forename: F
authors.initials: F
authors.lastname: Boitrelle
authors.forename: G
authors.initials: G
authors.lastname: Robin
authors.forename: F
authors.initials: F
authors.lastname: Marcelli
authors.forename: M
authors.initials: M
authors.lastname: Albert
authors.forename: B
authors.initials: B
authors.lastname: Leroy-Martin
authors.forename: D
authors.initials: D
authors.lastname: Dewailly
authors.forename: J-M
authors.initials: JM
authors.lastname: Rigot
authors.forename: V
authors.initials: V
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D053713:Azoospermia; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006801:Humans; D007265:Inhibins / Q000378:metabolism; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013737:Testis / Q000033:anatomy & histology
chemical_list: C422364:inhibin B; D007265:Inhibins; D005640:Follicle Stimulating Hormone