Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum94892Review ArticleThe prediction of outcomes of the testicular biopsy in patients with azoospermia using clinical, endocrine and genetic factorsToropovV. Atoropov-1990@mail.ruBorovetsS. Yusborovets@mail.ruTkachukV. Nurolog.kaf@mail.ruI.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation15072017197838528122021Copyright © 2017, Consilium Medicum2017Introduction. The prevalence of azoospermia in the population of all men is 1%, and among infertile men - 10-15%. The cause of azoospermia can be various clinical, endocrine, genetic and other factors. The purpose of the study: the identification of clinical, endocrine and genetic factors affecting the detection rate of spermatozoa with open testicular biopsy in patients with azoospermia. Patients and methods. 44 men with non-obstructive azoospermia aged from 20 to 55 years were examined. All patients had a wide range of instrumental, laboratory and physical methods of research before performing a testicular biopsy. In the blood plasma, the level of luteinizing (LH) and follicle-stimulating hormones (FSH), prolactin, total and free testosterone, estradiol, globulin, binding sex hormones was determined. Genetic tests included the study of the karyotype and the determination of the azoospermia factor. Results. In factor analysis, three factors were identified, that is, three sets of hormonal and clinical indicators that affect the outcome of an open testicular biopsy. It turned out that the explained variance reached 85%, and the individual significance of the third factor was highly informative. "Artificial neural network" allowed to reveal the factors influencing the frequency of detection of spermatozoa with open testicular biopsy. Conclusions. The outcome of testicular biopsy in patients with azoospermia is influenced by three groups of factors: the first - FSH and LH, the second - prolactin and age, the third - the age and total testosterone. The artificial neural network revealed the predictors of testicular sperm extraction (TESE) outcomes, which are a combination of clinical (the presence of an operation for varicocele in the past, the age of a patient older than 30 years), endocrine (high FSH), and genetic factors (Klinefelter syndrome, AZFc microdeletions).infertilityazoospermiafactor analysisartificial neural networkopen testicular biopsyбесплодиеазооспермияфакторный анализнейронная сетьоткрытая биопсия яичка[Aziz N. The importance of semen analysis in the context of azoospermia. Clinics (Sao Paulo) 2013; 68 (1): 35-8.][Esteves S.C, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo) 2011; 66: 691-700.][Витязева И.И. Современные подходы к лечению азооспермии методом микро-ТЕСЕ в программе ЭКО/ИКСИ. Обзор литературы. Часть II. Проблемы эндокринологии 2013; 59 (5): 47-60.][Esteves S.C, Agarwai A. The azoospermic male: current knowledge and future perspectives. Clinics (Sao Paulo) 2013; 68 (1): 1-4.][Шуметов В.Г., Шуметова Л.В. Факторный анализ: подход с применением ЭВМ. Орел: ОрелГТУ, 1999.][Хайкин С. Нейронные сети: полный курс. 2-е изд. М.: Вильямс, 2006.][Krausz C, Quinatana-Murci L, Mc Elreavey K. Prognostic value of Y deletion analysis: What is the clinical prognostic value of Y chromosome microdeletion analysis? Hum Reprod 2000; 15 (7): 1431-4.][Vogt P.H, Edelmann A, Kirsch S et al. Human Y chromosome azoospermia factors (AZF) mapped to different subregions in Yq11. Hum Mol Genet 1996; 5 (7): 933-43.][Selice R, Di Mambro A, Garolla A et al. Spermatogenesis in klinefelter syndrome. J Endocrinol Invest 2010; 33: 789-93.][Yarali Hakan. TESE-ICSI in patients with non - mosaic Klinefelter syndrome. RBM Online 2009; 18 (6): 756-60.][Schiff J.D, Palermo G.D, Veeck L.L et al. Success of testicular sperm extraction and intracytoplasmic sperm injection in men with Klinefelter syndrome. J Clin Endocrinol Metab 2005; 90 (11): 6263-7.][Wahlström T, Huhtaniemi I, Hovatta O, Seppälä M. Localization of luteinising hormone, follicle - stimulating hormone, prolactin, and their receptors in human and rat testis using immunohistochemistry and radio receptor assay. J Clin Endocrinol Metab 1983; 57: 825-30.][Tesarik J, Martinez F, Rienzi L et al. In - vitro effects of FSH and testosterone withdrawal on caspase activation and DNA fragmentation in different cell types of human seminiferous epithelium. Hum Reprod 2002; 17 (7): 1811-9.][Chausiaux O.E, Abel M.H, Baxter F.O et al. Hypogonadal mouse, a model to study the effects of the endogenous lack of gonadotrophins on apoptosis. Biol Reprod 2008; 78 (1): 77-90.][Калинченко С.Ю. Мифы и правда о гиперпролактинемии. Избранные лекции. М.: Практическая медицина, 2014.]