Among seven testis-specific molecular markers, SPEM1 appears to have a significant clinical value for prediction of sperm retrieval in azoospermic men

Abstract

Background: To achieve sperm retrieval in azoospermic men, predicting the success rate seems to be necessary. Objectives: In the present study we aimed to assess expression of seven molecular markers [ESX1, DAZ, DAZL (pre-meiotic markers), ZMYND15, PRM1, TNP1, and SPEM1 (post-meiotic markers)] to predict the success of sperm retrieval. Materials and Methods: In this study, 63 azoospermic men [16 OA (obstructive azoospermia) and 47 NOA (nonobstructive azoospermia)] undergoing testicular tissue microdissection (micro-TESE) for intracytoplasmic sperm injection (ICSI). Expression levels of these target genes were determined by real-time reverse transcription polymerase chain reaction using the DDCt method, and efficacy of each gene was compared by receiver operating characteristic (ROC) curve analysis. Results: Expression of post-meiotic transcripts significantly decreases in NOA and its subgroups (SCOS: Sertoli cell only syndrome, MA: maturation arrest, and HS: hypospermatogenesis) with spermatogenic failure compared to normal spermatogenesis (OA), with an exception of ZMYND15 for the HS group. These findings suggest the differential expression of the post-meiotic ZMYND15 marker is in accordance with histological findings and can discriminate HS from SCOS and MA. Post-meiotic markers were significantly reduced in negative vs. positive sperm retrieval groups. Discussion and Conclusion: Among the seven markers, SPEM1 had the best positive prediction power (96%) and negative prediction power (85%) at a 0.086 cutoff with the area under the curve (AUC) of 0.91 for receiver operating characteristic 4 (ROC) to predict the micro-TESE outcome.