Testicular Tissue Biopsies Sperms Yield of Non-Obstructive Azoospermic Men: Predictive Factors

Abstract

Background: Most testicular sperm retrieval procedures in non-obstructive Azoospermia (NOA) fail. Reliable pre-operative predictors remain undefined, and Iraqi data are scarce.
Objective: To evaluate clinical and hormonal predictors of successful testicular sperm retrieval in Iraqi men with NOA.
Methods: This prospective cross-sectional study enrolled 85 men with NOA undergoing conventional testicular sperm extraction at Al-Sadr Medical City in Najaf, Iraq (November 2025–May 2026). Age, body mass index (BMI), infertility duration and serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin and Inhibin B were compared between retrieval groups using Mann–Whitney U tests, univariate logistic regression and receiver operating characteristic analysis.
Results: Sperm were retrieved in 29/85 men (34.5%). Successful retrieval was associated with older age (33.62 ± 8.39 vs. 29.96 ± 5.85 years, p = 0.042), lower FSH (7.04 ± 4.48 vs. 11.59 ± 8.30 mIU/mL, p = 0.008) and lower LH (4.67 ± 2.35 vs. 7.61 ± 5.19 mIU/mL, p = 0.037). Discrimination was fair (area under the curve: FSH 0.676, LH 0.639). BMI, infertility duration, testosterone, prolactin and Inhibin B were not predictive.
Conclusions: FSH and LH were associated with retrieval outcome but discriminated only fairly. They should inform counselling, not exclude men from surgery.