Shear wave elastography for predicting the likelihood of sperm retrieval in microscopic testicular sperm extraction

Background: The gold standard procedure for retrieving mature sperm cells from the foci of spermatogenesis in the testicles of patients with nonobstructive azoospermia (NOA) is called microscopic testicular sperm extraction (micro-TESE). Shear wave elastography (SWE) is an imaging technique that measures the modulus of elasticity, which represents the stiffness of tissues. We investigated the effectiveness of testicular elastography in predicting the probability of sperm retrieval during micro-TESE in patients with azoospermia. Methods: We prospectively included 84 patients diagnosed with NOA who were scheduled to undergo micro-TESE. Prior to micro-TESE, testicular elastography was performed on all patients. Six SWE measurements were recorded for each patient, representing the right upper, right middle, right lower, left upper, left middle and left lower regions. After SWE measurement, the patients underwent a micro-TESE procedure performed by the same surgeon. The patients were divided into TESE-positive and TESE-negative groups. By contrast, statistically significant differences were observed between the Klinefelter Syndrome (KS) and non-KS groups in other clinical and hormonal parameters, including Follicle-Stimulating Hormone (FSH) (p = 0.003), Luteinizing Hormone (LH) (p = 0.001), Total Testosterone (TT) (p = 0.047), and estradiol (p = 0.041), p < 0.05 and TESE-negative. The hormone levels, SWE values, and genetics of the two groups of patients were compared. Results: Following the micro-TESE procedures, sperm retrieval was successful in 45 patients (53.57%) and unsuccessful in 39 patients (46.43%). There were no significant differences between the SWE values of the TESE-positive and TESE-negative groups. Significantly higher SWE values were found in the Klinefelter syndrome group than in patients with normal genetics. Conclusions: Although testicular elastography is a noninvasive and easily applicable imaging method, it cannot be used to predict sperm retrieval in patients with NOA. Clinical Trial Registration: The Unique Identifier NCT06524258 and the URL is https://clinicaltrials.gov/study/NCT06524258.

Shear wave elastography; Microscopic testicular sperm extraction; Azoospermia; Male infertility; Testis

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