Predictable Value Of Sperm Obtained From Azoospermia Patients By Analysis Of Genetics,Testicular Volume, Reproductive Hormone Level

Background and ObjectiveThe incidence of infertility increased significantly with the continuous development of industrial society, The WHO report, the male reproductive barriers ratio increasing year by year. Azoospermia is one of important factors causing male infertility. Specially non-obstructive azoospermia (NOA) patients, it’s difficult to treat and become troubled medical and social problems of human. The reason of azoospermia is quite complex, and it involve many kinds of factors, such as heredity, immune, infection, endocrine dysfunction. In recent years, due to the rapid development of the reproductive medicine, intracytoplasmic sperm injection (ICSI) emerged in assisted reproductive technology(ART) and widely application, through testicular sperm aspiration(TESA), can make the part of NOA patients to get consanguinity offspring. For NOA, looking for sperm has become the main job of andrology doctors. In assisted reproductive technology before treatment, should give full consideration to the diagnosis and treatment of traumatic indications. The traditional method of testicular incision biopsy, it’s an invasive procedure with bigger wound and lead to potential complications such as haematoma, inflammation, fibrosis, and even permanent devascularization to against patients later treatment. In addition, the application of testicular biopsy only as diagnosis method is less and less with deep understanding of the endocrinology and azoospermia etiology.Therefore, it’s necessary to find a simple and effective method which use non-invasive detection and differential diagnosis on azoospermia to predict spermatogenesis ability.This study will discuss the correlations and predictably value of the Y chromosome microdeletions, testicular volume and the reproductive hormone level with the result of testicular sperm aspiration(TESA) in NOA patients using comprehensive analysis on male infertility related measurement indicators.MethodsWe conducted semen analyses according to the WHO recommended standard and enlisted219azoospermia patients in this study, all azoospermia patients were measured in testicular volume,serum reproductive hormone level and15classical sequence-tagged sites in AZF regions of Y chromosome long arm were analyzed using multiplex PCR-electrophoresis.135NOA patients as NOA group received TESA and84OA patients were as control group, and then compare the difference of testicular volume, follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), tolal testosterone/luteinising hormone ratio (T/LH) and inhibin-B(INHB) levels between NOA and OA patients. NOA patients were divided into sperm group and non-sperm group according the TESA result. Then using receiver operator characteristic(ROC) curve to confirm the cut-off value and the area under curve(AUC) of measurement indicators of TESA predictable result and its evaluate sensitivity and specificity through comparing testicular volume, FSH, T/LH, Inhibin B levels and INHB/FSH ratio levels in sperm group and non-sperm group.Rusults 1.Sperm patients abnormal gene rate was11.90%and non-sperm patients abnormal gene was30.11%(χ2=5.191, p=0.023) in group NOA. ZAF microdeletion was8.89%in NOA group, and ZAF microdeletion was not found in OA group.2.There were significant differences on six testing indexes between NOA group and OA group. The average value of FSH,LH in NOA group were obviously higher than in OA group(t=16.950and9.897,p<0.001)and T,INHB,T/LH ratio, testicular volume significantly lower than in OAgroup(t=6.880,7.626,10.264and19.454,p<0.001).3.The testicular volume and INHB/FSH ratio of sperm group were significantly higher than non-sperm group in NOA patients. The testicular volume cut-off value was8.0ml result from ROC curve of testicular volume prediction TESA results, the sensitivity and specificity of it were95.2%and65.0%respectively, the AUC was0.839, the accuracy of diagnosis was medium. About INHB/FSH ratio to identity patients with sperm or no sperm, the AUC was0.962, the cut-off value of INHB/FSH was2.57, the sensitivity and specificity of it were83.3%and96.8%respectively, it indicated a high diagnostic accuracy. Also there were differences on FSH, T/LH in sperm group and non-sperm group but the diagnostic accuracy was low.Conclusion1.AZF microdeletion on Y chromosome patients of NOA almost have no useful normal sperm, deletion is one of the important reason of genetic to lead to the testis-derived azoospermia.2.1t’s a valuable reference using serum FSH and T/LH ratio level in the differential diagnosis of azoospermia, but the prediction results of TESA in NOA patients were low sensitivity.3.It’s significance to predict the fine result of NOA patients using testicular volume and INHB/FSH ratio.