History of cryptorchidism and ejaculate volume as simple predictors for the presence of testicular sperm.

Testicular volume, hormones, and growth factors are used as predictors of finding motile testicular sperm in azoospermic men. In this study, the possible predictive value of very simple parameters such as systematic history, clinical examination, and determination of ejaculate volume have been evaluated. Two-hundred and sixty-two consecutive non-vasectomized men with azoospermia/aspermia were evaluated by systematic history, clinical examination, ultrasonography of the scrotal content, and hormonal and genetic analyses. Hormonal analyses included, as a minimum, determination of follicular stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, while genetic analyses included karyotyping and examination for cystic fibrosis transmembrane conductance regulator (CFTR) mutations and Y microdeletions. In seventy-six cases (29%) genetics was the most likely cause of azoospermia. For men with at least one CFTR mutation, motile sperm could be detected in 100% of 13 men with congenital bilateral absence of vasa deferentia (VD) but only in 44% of 18 with present VD. Ejaculate volumes were significantly lower (2.3 mL versus 3.6 mL) in 81 men with motile testicular sperm detected compared to 111 men without detectable motile sperm (p < 0.001; Student's t-test), and the difference was still significant after exclusion of men carrying a CFTR mutation. Based on the present data, an ejaculate volume of 2.5 mL was considered a useful threshold value. Furthermore, an inhomogeneous histological pattern with maturation of sperm in small islands isolated in tissue showing Sertoli cell only (SCO) pattern seems characteristic for men with a history of cryptorchidism (negative predictive value: 95%). In addition to FSH, testicular volume, and other endocrine factors, it is important to consider that very simple factors such as ejaculate volume and presence or absence of VD in men with CFTR mutations might be used as predictors according to the chance of finding motile testicular sperm. Evidence for a strong association between a history of cryptorchidism and an inhomogeneous histological pattern with maturation of sperm in islands in tissue presenting SCO pattern might indicate that multiple TESEs should be considered in men with a history of cryptorchidism.