Shyaw M. Ahmed a, Lusan A. Arkawazi b, Kawa A. Mahmood c, and Ismaeel H.A. Aghaways a

a Dept. of Surgery-Urology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq. 

b Dept. of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq. 

c Dept. of Radiology, College of Medicine, University of Sulaimani, Kurdistan Region-Iraq. 

Submitted: 1/7/2020; Accepted: 22/11/2020; Published: 21/6/2021

DOI Link: https://doi.org/10.17656/jsmc.10295 



Before conducting any invasive surgical sperm retrieval in men with azoospermia, it is worth looking at certain factors to predict the chance of finding viable sperm eligible for Intracytoplasmic Sperm Injection.


Evaluating the outcome of percutaneous testicular sperm aspiration in men with azoospermia and the predictive value of serum Follicular Stimulating Hormone (FSH), testicular volume, and testicular strain elastography on the sperm retrieval rate


Cross-sectional prospective study on 73 men with azoospermia who have had their testicular volume and serum FSH measured before conducting percutaneous sperm aspiration. Fifteen men were also recruited to undergo testicular elastography. Age, FSH, testicular volume, and strain ratio on elastography were correlated with the outcome of sperm retrieval. 


Mean age was 36 years (range 19-69), 48% of them have had positive sperm retrieval. Twenty-five cycles of Intracytoplasmic Sperm Injection were performed, 8 (32%) have had positive β-hCG test and 4 (16%) live-birth rates. Serum FSH was the only predictive factor of percutaneous sperm retrieval (p=0.013) on multivariate analysis. The strain ratio was shown to be significantly different between men with negative and positive sperm aspirations (p=0.02). 


Percutaneous testicular sperm aspiration has a satisfactory retrieval rate in men with azoospermia. A combination of serum FSH and testicular strain elastography seems a promising tool that can potentially be used as guidance for predicting the outcome of surgical sperm retrieval.


Azoospermia, Surgical sperm retrieval, Percutaneous TESA, Ultrasound Elastography.


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