Comparison of upper, middle, and lower pole pathologic biopsies of the testes in patients with non-obstructive azoospermia
Bibliographic record
Abstract
INTRODUCTION: Infertility is a widespread global health issue with a multifactorial etiology, affecting a significant proportion of couples. Male factors, either alone or in combination with female factors, play a crucial role in contributing to infertility. Non-obstructive azoospermia (NOA), characterized by the absence of sperm in the ejaculate due to spermatogenic failure, represents one of the most severe forms of male infertility. Microdissection testicular sperm extraction (m-TESE) has emerged as a primary therapeutic approach for these patients. This study aimed to investigate histopathologic variances between different poles of the testicles in NOA patients undergoing m-TESE and to compare the results using the Johnsen testicular biopsy classification. METHODS: Forty-two consecutive NOA patients who underwent m-TESE between November 2022 and December 2023 were included in this prospective study. Data on patient demographics, perioperative variables, and postoperative outcomes were collected and analyzed. Testicular biopsies from the upper, middle, and lower poles were histopathologically examined, and the Johnsen testicular biopsy scoring system was used for comparison. RESULTS: Histologic evaluation revealed Sertoli cell-only syndrome in nine cases (SCO), maturation arrest (MA) in 12 cases, and hypospermatogenesis (HS) in 21 cases. Pathologic findings were consistent across all poles of the testicle. Johnsen testicular biopsy scores showed similar results among patients. The success rates of sperm retrieval varied, with two of nine patients with SCO, four of 12 with MA, and 16 of 21 with HS achieving successful results. CONCLUSIONS: Our study demonstrated consistent histopathologic patterns across different poles of the testis, emphasizing the importance of comprehensive histologic assessment for predicting sperm retrieval success. As a result of our study, we found that the upper middle and lower poles of the testis were similar in terms of histologic and Johnsen testicular biopsy scoring system. Future research should focus on refining histopathologic classification systems and further optimizing surgical techniques to enhance outcomes in this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".