P-047 Sperm retrieval rate of micro-TESSE among non-obstructive azoospermia: Addressing the role of APHRODITE criteria
V Ngo Dinh Trieu, Y Duong B., L Nguyen M. T., K Le D., H Duong Q., N Giang H.Abstract
Study question
How does applying the APHRODITE criteria impact the sperm retrieval rate in non-obstructive azoospermia (NOA) patients undergoing micro-TESE?
Summary answer
The APHRODITE could classify poor prognostic patients and predict the sperm retrieval rates in micro-TESE, highlighting its role in patient selection and counseling.
What is known already
Microsurgical testicular sperm extraction (micro-TESE) is the gold standard for sperm retrieval in non-obstructive azoospermia (NOA), but predicting sperm retrieval success remains challenging. The novel APHRODITE is a simple criterion for patients with male infertility based on clinical and hormonal factors to improve the reproductive outcome. However, data on applying these criteria to NOA populations remains limited. This study evaluated the role of the APHRODITE criteria in micro-TESE outcomes.
Study design, size, duration
The study was designed as a cross-sectional study. We retrospectively analyzed the outcome of 205 NOA patients who underwent Micro-TESE at IVFTA HCM, Tam Anh General Hospital, Vietnam, from 2021 to 2023.
Participants/materials, setting, methods
All patients underwent comprehensive clinical and laboratory evaluation for non-obstructive azoospermia (NOA), including hormonal profiling, genetic testing, and testicular volume assessment. Patients were classified according to the APHRODITE criteria into Groups 2, 3, and 4, based on clinical and biochemical prognostic factors. Microsurgical testicular sperm extraction (micro-TESE) was performed for all patients. Multivariate logistic regression analysis evaluated the association between patient variables, including age, clinical factors, genetic markers, APHRODITE group, and sperm retrieval success.
Main results and the role of chance
We found no significant differences in clinical factors or hormonal profiles associated with sperm retrieval success, except in patients with Klinefelter syndrome, who demonstrated a significantly lower sperm retrieval rate (SRR = 6% [2/17], p = 0.026). The overall SRR among non-obstructive azoospermia (NOA) patients was 40%. Using the APHRODITE criteria, Group 4 included the most significant proportion of patients (77.9%, 158/205) but demonstrated the lowest SRR of 36%, compared with Group 2 (SRR = 62.9%) and Group 3 (SRR = 40%, p = 0.031). Interestingly, while Follicle-stimulating hormone (FSH) and Testosterone concentrations were not significantly associated with SRR, multivariate logistic regression analysis revealed significant findings. APHRODITE group 4 was associated with significantly lower sperm retrieval (OR: 4.43, 95% CI: 1.62–12.16, p = 0.0038). Group 3 showed decreased retrieval rates, although not statistically significant (OR: 3.02, 95% CI: 0.87–10.53, p = 0.082). Increasing age was associated with retrieval failure (OR: 0.95, 95% CI: 0.91–0.99, p = 0.032). Other variables, such as testicular volume, genetic markers, history of mumps, varicocele surgery, Klinefelter syndrome and previous unsuccessful retrieval attempts, were not significant predictors.
Limitations, reasons for caution
The study limitations include the retrospective collection, which can lead to selection bias. Additionally, the small sample size and the applicability of the results to all NOAs should be considered.
Wider implications of the findings
These findings highlight the usefulness of the APHRODITE criteria among NOA patient underwent micro-TESE, especially for Group 4 patients, which may enhance patient counseling, optimize surgical planning, and refine treatment strategies for NOA, contributing to more effective and personalized fertility care.
Trial registration number
No