Sperm Retrieval in Men with AZFc Microdeletions Is Independent of Age but Associated with Intermediate FSH Levels.
Academic Article
Overview
abstract
INTRODUCTION: Y-chromosome microdeletions, particularly in the AZFc region, are a common genetic cause of male infertility. This study evaluates sperm retrieval rates (SRR) and testicular histology across age groups in men with isolated AZFc deletions. MATERIALS AND METHODS: We identified men with isolated complete AZFc microdeletions who underwent mTESE from 2000-2024. Genitourinary pathology reports categorized histology as Sertoli-cell only, tubular atrophy, maturation arrest, or hypospermatogenesis. Chi-square tests compared histology and SRR. Multivariable logistic regression assessed factors associated with successful sperm retrieval. RESULTS: Of 1,473 patients who underwent Y-chromosome microdeletion testing, 72 with isolated AZFc microdeletions underwent mTESE. Patients were stratified by age ≤35 years (n=51) and >35 years (n=21). Overall, germ cells were identified in 59.7% of cases, with no difference between patients ≤35 years (58.8%) and >35 years (61.9%) (P=0.81). The overall SRR was 50%, with no difference by age group (≤35 years: 51.0%, >35 years: 47.6%; P=0.80). On multivariable analysis, age >35 years (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. FSH levels between 12.4-24.0 mIU/mL were associated with higher SRR (OR 7.04, 95% CI [1.83, 27.1]). CONCLUSION: Patient age was not a strong predictor of sperm retrieval success in men with complete AZFc deletion. FSH levels within an intermediate range were associated with higher sperm retrieval rates, suggesting hormonal context may inform patient counseling. Reproductive urologists should counsel patients that age alone is unlikely to meaningfully influence sperm retrieval.
