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Multimodal Ultrasonography Predicts Sperm Retrieval Success in Nonobstructive Azoospermia: A Retrospective Diagnostic
Guocheng Lu1, Qisheng Tang2, Tianyu She3
1Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
Ultrasound in Medicine & Biology
|August 10, 2026
Summary
A new multimodal ultrasound model accurately predicts sperm retrieval success in nonobstructive azoospermia (NOA) patients undergoing Micro-TESE. This noninvasive tool combines testicular volume, contrast-enhanced ultrasound (CEUS), and elastography to guide surgical decisions.
Area of Science:
- Reproductive Medicine
- Medical Imaging
- Urology
Background:
- Nonobstructive azoospermia (NOA) presents a significant challenge for male infertility.
- Predicting sperm retrieval success in NOA patients is crucial for optimizing treatment and minimizing surgical morbidity.
- Current predictive methods lack sufficient accuracy, necessitating improved diagnostic tools.
Purpose of the Study:
- To develop and validate a multimodal ultrasound model for preoperative prediction of sperm retrieval success in NOA patients.
- To integrate testicular volume, contrast-enhanced ultrasound (CEUS) parameters, and shear-wave elastography (SWE) into a predictive model.
- To assess the model's ability to optimize patient selection for microdissection testicular sperm extraction (Micro-TESE).
Main Methods:
- Retrospective analysis of 112 NOA patients undergoing Micro-TESE.
- Acquisition and comparison of multimodal ultrasound parameters: testicular volume, CEUS-derived arterial transit time (AT) and area under the curve (AUC), and SWE stiffness.
- Statistical analysis using multivariate logistic regression and receiver operating characteristic (ROC) curve evaluation.
Main Results:
- Successful sperm retrieval was associated with larger testicular volume, higher CEUS AUC, and shorter AT (p < 0.05).
- Multimodal ultrasound parameters (volume, AT, AUC) were confirmed as independent predictors of sperm retrieval success.
- The combined predictive model achieved an AUC of 0.861, with 81.4% sensitivity and 75.0% specificity.
Conclusions:
- Multimodal ultrasonography offers a valuable, noninvasive method for predicting sperm retrieval outcomes in NOA.
- A diagnostic model integrating testicular volume, CEUS hemodynamics, and elastography can enhance patient selection for Micro-TESE.
- This approach may reduce unnecessary surgical interventions and associated morbidity in NOA patients.