NOA masquerading as OA: Rethinking the role of testis biopsy from an East Asian perspective

The Schoor criteria, derived from a Caucasian cohort, may be unsuitable for East Asian patients, given the much lower NPVs for pOA in our cohort (25.8%) than that in the Schoor study (92.3%). These findings highlight the limitations of relying solely on clinical criteria, either Schoor or Huang, to guide sperm retrieval strategies, including the choice of retrieval method and microsurgical approach. Therefore, a testicular biopsy is essential to confirm complete spermatogenesis in patients with clinically phOA.