{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:48:09Z","timestamp":1792460889546,"version":"4.5.0"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Non-obstructive azoospermia (NOA) presents a challenge in male infertility management. This study aimed to assess the efficacy of diagnostic testicular biopsy (DTB) in predicting sperm retrieval success via therapeutic testicular biopsy (TTB) and to understand the role of systemic inflammation in microdissection testicular sperm extraction (mTESE) outcomes. Methods: A retrospective analysis was conducted on 50 NOA males who underwent mTESE at the University of Ioannina\u2019s Department of Urology from January 2017 to December 2019. All participants underwent thorough medical evaluations, including semen analyses and endocrinological assessments. Results: DTB did not detect spermatozoa in half of the patients who later showed positive sperm findings in TTB. Preoperative variables, such as age, plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), prolactin (PRL), estradiol (E2), and inflammation biomarkers (neutrophil\u2013lymphocyte ratio (NLR), platelet\u2013lymphocyte ratio (PLR), monocyte\u2013eosinophil ratio (MER)), were not consistently predictive of sperm retrieval success. Notably, TTB-negative patients had elevated NLR and PLR values, suggesting a possible link between systemic inflammation and reduced sperm retrieval during mTESE. Conclusions: The findings question the necessity of an initial DTB, which might provide misleading results. A negative DTB should not deter further TTB or intracytoplasmic sperm injection (ICSI) attempts. The study emphasizes the need for further research to refine diagnostic approaches and deepen the understanding of factors influencing sperm retrieval in NOA patients, ultimately enhancing their prospects of biological parenthood.<\/jats:p>","DOI":"10.3390\/jpm13091362","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T09:51:37Z","timestamp":1694080297000},"page":"1362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Evaluating the Predictive Value of Diagnostic Testicular Biopsy for Sperm Retrieval Outcomes in Men with Non-Obstructive Azoospermia"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4651-312X","authenticated-orcid":false,"given":"Aris","family":"Kaltsas","sequence":"first","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftheria","family":"Markou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5287-4450","authenticated-orcid":false,"given":"Athanasios","family":"Zachariou","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1198-9144","authenticated-orcid":false,"given":"Fotios","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6360-0762","authenticated-orcid":false,"given":"Evangelos N.","family":"Symeonidis","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Zikopoulos","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8662-1275","authenticated-orcid":false,"given":"Charalampos","family":"Mamoulakis","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, University of Crete, 70013 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8605-2968","authenticated-orcid":false,"given":"Dung Mai Ba","family":"Tien","sequence":"additional","affiliation":[{"name":"Department of Andrology, Binh Dan Hospital, Ho Chi Minh City 70000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Takenaka","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Sofikitis","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e28218","DOI":"10.4161\/spmg.28218","article-title":"Review of Azoospermia","volume":"4","author":"Wosnitzer","year":"2014","journal-title":"Spermatogenesis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/aja.2012.141","article-title":"Microdissection Testicular Sperm Extraction: An Update","volume":"15","author":"Dabaja","year":"2012","journal-title":"Asian J. Androl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"555","DOI":"10.4103\/aja.aja_137_19","article-title":"Sperm retrieval success and testicular histopathology in idiopathic nonobstructive azoospermia","volume":"22","author":"Das","year":"2020","journal-title":"Asian J. Androl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/aja.aja_5_17","article-title":"Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: A meta-analysis","volume":"20","author":"Li","year":"2018","journal-title":"Asian J. Androl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1111\/andr.12417","article-title":"Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction: A pilot study","volume":"5","author":"Yucel","year":"2017","journal-title":"Andrology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"659","DOI":"10.4103\/1008-682X.153539","article-title":"Varicocele and Testicular Function","volume":"17","author":"Pastuszak","year":"2015","journal-title":"Asian J. Androl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/humrep\/del279","article-title":"Histological Evaluation of the Human Testis\u2014Approaches to Optimizing the Clinical Value of the Assessment: Mini Review","volume":"22","author":"McLachlan","year":"2006","journal-title":"Hum. Reprod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3041565","DOI":"10.1155\/2017\/3041565","article-title":"The Role of Hematological Indices in Patients with Acute Coronary Syndrome","volume":"2017","author":"Budzianowski","year":"2017","journal-title":"Dis. Markers"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.kjms.2017.08.010","article-title":"Microdissection testicular sperm extraction (micro-TESE): Predictive value of preoperative hormonal levels and pathology in non-obstructive azoospermia","volume":"34","author":"Eken","year":"2018","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/j.1464-410X.2012.11203.x","article-title":"Testicular Histopathology as a Predictor of a Positive Sperm Retrieval in Men With Non-Obstructive Azoospermia","volume":"111","author":"Raheem","year":"2012","journal-title":"BJU Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.2047-2927.2012.00003.x","article-title":"Sperm Retrieval and Live Birth Rates in Presumed Sertoli-Cell-Only Syndrome in Testis Biopsy: A Single Centre Experience","volume":"1","author":"Gul","year":"2012","journal-title":"Andrology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.eururo.2021.08.014","article-title":"European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility","volume":"80","author":"Minhas","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1439-0272.2004.00615.x","article-title":"Role of testicular tissue telomerase assay for the prediction of the presence of testicular spermatozoa in azoospermic men with varicoceles, pre- and post-varicocelectomy","volume":"36","author":"Giannakis","year":"2004","journal-title":"Andrologia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1093\/humrep\/13.10.2791","article-title":"Enzymatic digestion of testicular tissue may rescue the intracytoplasmic sperm injection cycle in some patients with non-obstructive azoospermia","volume":"13","author":"Crabbe","year":"1998","journal-title":"Hum. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1093\/humrep\/14.12.3041","article-title":"Highly sensitive quantitative telomerase assay of diagnostic testicular biopsy material predicts the presence of haploid spermatogenic cells in therapeutic testicular biopsy in men with Sertoli cell-only syndrome","volume":"14","author":"Yamamoto","year":"1999","journal-title":"Hum. Reprod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0015-0282(16)58048-0","article-title":"Beneficial effects of electrical stimulation before round spermatid nuclei injections into rabbit oocytes on fertilization and subsequent embryonic development","volume":"65","author":"Sofikitis","year":"1996","journal-title":"Fertil. Steril."},{"key":"ref_17","unstructured":"WHO (2000). WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple, Cambridge University Press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/0140-6736(92)92425-F","article-title":"Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte","volume":"340","author":"Palermo","year":"1992","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1093\/HUMREP\/10.6.1457","article-title":"Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia","volume":"10","author":"Devroey","year":"1995","journal-title":"Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s12522-016-0234-z","article-title":"Management of non-obstructive azoospermia","volume":"15","author":"Chiba","year":"2016","journal-title":"Reprod. Med. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Male Reproduction and Urology (2019). The management of obstructive azoospermia: A committee opinion. Fertil. Steril., 111, 873\u2013880.","DOI":"10.1016\/j.fertnstert.2019.02.013"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1093\/humupd\/dmz028","article-title":"Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: A systematic review and meta-analysis","volume":"25","author":"Corona","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Marinaro, J., and Goldstein, M. (2022). Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154593"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/j.1464-410X.2012.11714.x","article-title":"Factors Influencing Intracytoplasmic Sperm Injection (ICSI) Outcome in Men With Azoospermia","volume":"112","author":"Raheem","year":"2013","journal-title":"BJU Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2147\/TACG.S267421","article-title":"Y-Chromosome Microdeletions: A Review of Prevalence, Screening, and Clinical Considerations","volume":"14","author":"Rabinowitz","year":"2021","journal-title":"Appl. Clin. Genet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1093\/humrep\/13.3.709","article-title":"Ooplasmic injection of elongating spermatids for the treatment of non-obstructive azoospermia","volume":"13","author":"Sofikitis","year":"1998","journal-title":"Hum. Reprod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/S0140-6736(05)79121-2","article-title":"Ooplasmic injections of secondary spermatocytes for non-obstructive azoospermia","volume":"351","author":"Sofikitis","year":"1998","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1093\/humupd\/4.3.197","article-title":"Micro- and macro-consequences of ooplasmic injections of early haploid male gametes","volume":"4","author":"Sofikitis","year":"1998","journal-title":"Hum. Reprod. Update"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/aja.2011.57","article-title":"Testicular biopsy: Clinical practice and interpretation","volume":"14","author":"Dohle","year":"2012","journal-title":"Asian J. Androl."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1111\/j.1365-2605.2011.01204.x","article-title":"A pathologist\u2019s view on the testis biopsy","volume":"34","author":"Oosterhuis","year":"2011","journal-title":"Int. J. Androl."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1093\/humrep\/14.1.131","article-title":"Testicular sperm extraction: Microdissection improves sperm yield with minimal tissue excision","volume":"14","author":"Schlegel","year":"1999","journal-title":"Hum. Reprod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/andr.12067","article-title":"Age and Markers of Leydig Cell Function, but Not of Sertoli Cell Function Predict the Success of Sperm Retrieval in Adolescents and Adults With Klinefelter\u2019s Syndrome","volume":"3","author":"Rohayem","year":"2015","journal-title":"Andrology"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kaltsas, A., Moustakli, E., Zikopoulos, A., Georgiou, I., Dimitriadis, F., Symeonidis, E.N., Markou, E., Michaelidis, T.M., Tien, D.M.B., and Giannakis, I. (2023). Impact of Advanced Paternal Age on Fertility and Risks of Genetic Disorders in Offspring. Genes, 14.","DOI":"10.3390\/genes14020486"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s12522-015-0212-x","article-title":"Predictive Factors of Successful Sperm Retrieval on Microdissection Testicular Sperm Extraction in Japanese Men","volume":"15","author":"Enatsu","year":"2015","journal-title":"Reprod. Med. Biol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/1477-7827-8-108","article-title":"Appropriate Cut-Off Value for Follicle-Stimulating Hormone in Azoospermia to Predict Spermatogenesis","volume":"8","author":"Chen","year":"2010","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Symeonidis, E.N., Evgeni, E., Palapelas, V., Koumasi, D., Pyrgidis, N., Sokolakis, I., Hatzichristodoulou, G., Tsiampali, C., Mykoniatis, I., and Zachariou, A. (2021). Redox Balance in Male Infertility: Excellence through Moderation-\u201cMuepsilontaurhoomicronnu \u1f04rhoiotasigmatauomicronnu\u201d. Antioxid, 10.","DOI":"10.3390\/antiox10101534"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S0090-4295(00)00908-0","article-title":"Microsurgical inguinal varicocele repair in azoospermic men","volume":"57","author":"Kadioglu","year":"2001","journal-title":"Urology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"15","DOI":"10.6061\/clinics\/2013(Sup01)03","article-title":"The epidemiology and etiology of azoospermia","volume":"68","author":"Cocuzza","year":"2013","journal-title":"Clinics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"811487","DOI":"10.3389\/frph.2022.811487","article-title":"Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not","volume":"4","author":"Kaltsas","year":"2022","journal-title":"Front. Reprod. Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/014850190884318","article-title":"Is Varicocele a Prognostic Factor for Determining Sperm Retrieval Rate Before Testicular Sperm Extraction?","volume":"51","author":"Tunc","year":"2005","journal-title":"Arch. Androl."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/9\/1362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:46:44Z","timestamp":1760129204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/9\/1362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jpm13091362"],"URL":"https:\/\/doi.org\/10.3390\/jpm13091362","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]}}}