Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia

Background About half of all infertility cases among couples globally are caused by male infertility. Azoospermia, in which no sperm are detected in the ejaculate, affects around 1% of the male population and 10–15% of males who experience infertility. There are two kinds, obstructive and non-obstructive, and the reasons for and methods of treating each are different. To solve this problem, in vitro fertilization (IVF) can be used to harvest sperm. Although there are many methods for sperm retrieval, micro-testicular sperm extraction (Micro-TESE) allows for the most accurate retrieval with the least amount of tissue injury. Aim This study aims to enhance results and decrease treatment costs by identifying predictive characteristics of successful micro-TESE in NOA patients. Methods This prospective study (May 2022–May 2024, Qena University Hospital) included NOA patients, including those undergoing redo procedures or with a single testis. Exclusion criteria covered obstructive causes, surgeries, infections, or genetic issues. All underwent detailed hormonal, clinical, and imaging assessments, and micro-TESE was performed using magnification to preserve tissue. Outcomes assessed included sperm retrieval, histopathology (Juhanson Score), complications, and pregnancy rates. Results Mean male age was 38.83 ± 9.91 years; 60.67% were smokers. Mean wife age was 30.03 ± 6.03 years; infertility duration averaged 6.76 ± 5.59 years. Successful micro-TESE was associated with older age, larger testicular size, prior treatment, lower FSH, LH, E2, and prolactin, and higher testosterone (p < 0.05). Juhanson score, testicular side, and sperm concentration also predicted success. ROC analysis showed strong predictors: age < 34.5 years (67.4% sensitivity), testis size < 7.5 cm (≥ 72% sensitivity), testosterone > 4.765 ng/mL (90.6% sensitivity), and Juhanson score < 1.5 (97.2% sensitivity, 72.7% specificity). Conclusion Key predictors of micro-TESE success in NOA include hormone levels, testicular size, prior treatment, and histopathology score, aiding in better case selection and outcome prediction.