Sperm Retrieval in Men With AZFc Microdeletions Is Independent of Age but Associated With Intermediate...

Y-chromosome microdeletions, particularly in the azoospermia factor c (AZFc) region, are a common genetic cause of male infertility. This study evaluates sperm retrieval rates (SRRs) and testicular histology across age groups in men with isolated AZFc deletions.

We identified men with isolated complete AZFc microdeletions who underwent microdissection testicular sperm extraction from 2000 to 2024. Genitourinary pathology reports categorized histology as Sertoli cell-only, tubular atrophy, maturation arrest, or hypospermatogenesis. χ² tests compared histology and SRR. Multivariable logistic regression assessed factors associated with successful sperm retrieval.

Of 1473 patients who underwent Y-chromosome microdeletion testing, 72 with isolated AZFc microdeletions underwent microdissection testicular sperm extraction. Patients were stratified by age 35 years or younger (n = 51) and older than 35 years (n = 21). Overall, germ cells were identified in 59.7% of cases, with no difference between patients 35 years or younger (58.8%) and older than 35 years (61.9%; P = .81). The overall SRR was 50%, with no difference by the age group (≤35 years: 51.0%, older than 35 years: 47.6%; P = .80). On multivariable analysis, age older than 35 years (odds ratio [OR] 0.82, 95% CI [0.28-2.40]) and the presence of spermatogenesis during biopsy (OR 1.66, 95% CI [0.59-4.69]) were not associated with SRR. Follicle-stimulating hormone levels between 12.4 and 24.0 mIU/mL were associated with higher SRR (OR 7.04, 95% CI [1.83-27.1]).

Patient age was not a strong predictor of sperm retrieval success in men with complete AZFc deletion. Follicle-stimulating hormone levels within an intermediate range were associated with higher SRRs, suggesting that hormonal context may inform patient counseling. Reproductive urologists should counsel patients that age alone is unlikely to meaningfully influence sperm retrieval.