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

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).

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.

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).

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.