Correlation between high Choline metabolite signal in spectroscopy and sperm retrieval chance at micro-TESE.

To determine the relationship between choline (Cho) signal intensity measured before micro-dissection testicular sperm extraction (micro-TESE) and sperm retrieval rates in mTESE in non-obstructive azoospermia (NOA) patients. A total of 20 patients who underwent testicular MR spectroscopy were included in the study. Participants consisted of 10 patients diagnosed with NOA and 10 fertile cases with normal sperm counts. Both groups of participants underwent bilateral testis MR spectroscopy. Ten patients in the NOA group underwent mTESE after spectroscopy. The signal intensities of Cho, creatine (Cr), lactate, and lipids were analyzed and compared with the results of fertile control. Cho signal intensity detected before mTESE in the NOA group and sperm retrieval rates were compared. Sperm was found in 5 of 10 patients who underwent mTESE. No sperm was found in five NOA cases. The main metabolites detected in NOA cases with sperm in mTESE were Cho and Cr. Cho and Cr signals were found to be significantly lower in NOA cases where no sperm could be found in mTESE. Cho and Cr signal intensities of the fertile group were similar to NOA patients with sperm in mTESE but were significantly higher than those with NOA without sperm. While the cut-off value of Cho was 1.24 ppm (AUC 0.665, p = 0.01 [95% CI: 0.722-1.00]) the cut-off value of Cr was 1.18 ppm (AUC 0.887, p = 0.02 [95% CI]): 0.620-1.00]) for positive sperm retrieval. Detection of high Cho metabolite in the spectra before TESE in NOA patients increases sperm retrieval rates in mTESE.