OBJECTIVE: To evaluate novel preoperative hormonal predictors of sperm retrieval success in men with idiopathic non-obstructive azoospermia (NOA) undergoing microsurgical testicular sperm extraction (mTESE). DESIGN: Multi-institutional retrospective cohort study conducted between 2014 and 2024. SUBJECTS: 60 men with strictly defined idiopathic NOA from multiple sites participating in the MOBYUS Male Infertility Research Consortium were included, comprising a prediction cohort (n=30) and an independent multi-institutional validation cohort (n=30). Idiopathic NOA was defined by azoospermia on two separate semen analyses without prior paternity, evidence of obstruction, prior genitourinary surgery, documented genetic abnormalities, or use of empirical medical therapy within one year prior to surgery. Sensitivity analyses were performed by excluding men with FSH 20 and LH<10) that achieved 93% sensitivity and 81% specificity for predicting sperm retrieval success. CONCLUSION: This multi-institutional study demonstrates that the T/FSH ratio is a reproducible and clinically meaningful predictor of sperm retrieval success in men with idiopathic NOA. Across two independent and diverse cohorts, this ratio consistently outperformed single-hormone predictors and remained the only externally validated preoperative predictor of mTESE success.
Siva et al. (Sat,) studied this question.