Predictive value of testicular elastography on the outcome of percutaneous testicular sperm aspiration in patients with azoospermia

Infertility is a significant issue affecting approximately 8–12% of couples, with 10–30% of cases attributed to azoospermia. Elastography, a novel ultrasound technique, can assess testis elasticity and provide insight into the presence or absence of sperm. To evaluate the diagnostic utility of testicular elastography in infertile men and correlate elastography parameters with semen analysis and hormonal profiles. This prospective cross-sectional study was conducted on 51 infertile men with primary infertility diagnosed with azoospermia. The study was conducted between February 2022 and March 2023 at Sulaimaia Teaching Hospital, and the patients were recruited from a private fertility clinic in Sulaimani, Kurdistan Region, Iraq. Clinical history, physical examination, testicular ultrasound elastography, and hormonal assays were performed. pTESA was also carried out, and the histological type of testicular tissue was determined. The average age of patients was 34.41 years. Testicular strain elastography (Rt) can predict pTESA with 91.4% sensitivity and 93.8% specificity. Testicular strain elastography (Lt) can predict percutaneous TESA with 82.9% sensitivity and 93.8% specificity. The mean FSH level was 14.625 mlU/ml, and the mean volume for the 51 patients was 8.307 ml. Testicular elastography offers a non-invasive, quantitative assessment of testicular parenchymal integrity and correlates well with spermatogenic function. It may serve as a valuable adjunct to conventional infertility workup, particularly in differentiating functional impairment from obstructive causes.