Clinical outcomes and predictive factors of microsurgical varicocelectomy in men with idiopathic non-obstructive azoospermia or cryptozoospermia: a retrospective cohort study

Objective To evaluate clinical outcomes and non-invasive predictors of ejaculated sperm recovery after microsurgical varicocelectomy in men with idiopathic non-obstructive azoospermia (iNOA) or cryptozoospermia. Methods We retrospectively analyzed the clinical data of patients with iNOA or cryptozoospermia and varicocele at the First Affiliated Hospital of Fujian Medical University from January 2017 to January 2024. All patients were concurrently diagnosed with clinical varicocele via combined Doppler ultrasound and physical examination, and all underwent subinguinal microscopic varicocelectomy. A total of 30 patients were included in the study and followed-up for at least 1 year. Patients were divided into two groups according to their postoperative outcomes. The differences in various parameters between the two groups were compared. Univariate logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for each predictor. The logistic regression model was used to evaluate the association between sperm recovery and clinical factors. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of predictive factors. Results Among the 30 patients who received microsurgical varicocelectomy, motile sperm was detected in postoperative ejaculates in nine patients (30.0%). Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels differed significantly between the two groups ( P < 0.05). Binary logistic regression analysis of age, mean testicular volume, FSH, LH and testosterone (T) levels showed that only FSH was associated with sperm recovery after surgery, while FSH was negatively associated with sperm recovery (OR = 0.587, 95% CI [0.345–0.998], P = 0.049). There was no statistically significant correlation between the other parameters. ROC analysis showed that preoperative serum FSH level could effectively predict sperm recovery after surgery (area under curve (AUC) = 0.931, 95% CI [0.805–1.000]). The sensitivity of FSH was 95.2%, the specificity was 88.9%, and the cutoff value was 10.86. Conclusions Microscopic varicocelectomy for the treatment of iNOA or cryptozoospermia may benefit a subset of patients, with motile sperm appearing in the non-centrifuged semen postoperatively. Preoperative serum FSH level serves as an independent predictive biomarker for postoperative sperm recovery among men with iNOA. Lower baseline FSH values correlate with a greater probability of detectable motile sperm in ejaculate after microsurgical varicocelectomy.