The likelihood of finding mature sperm cells in men with AZFb or AZFb-c deletions: Six new cases and a review of the literature (1994-2010)

Objective: To reassess the predictive value of detecting sperm cells in men with AZFb or AZFb-c deletions. Design: Retrospective analysis of previously reported men with AZFb or AZFb-c deletions and the addition of six new cases. Setting: Fertility institution. Patient(s): Men with both sequence tagged site marker identification and testicular cytology/histology findings. Intervention(s): Systematic review of reported men with microdeletions that included eligibility, data extraction and analysis. Main Outcome Measure(s): Availability of sperm cells for intracytoplasmic sperm injection (ICSI) in men with AZFb/AZFb-c microdeletions. Result(s): The average prevalences reported for AZFb, AZFb-c, partial AZFb, and partial AZFb-c in azoospermic men were 0.9% ± 0.07%, 2.7% ± 0.93%, 1.23% ± 0.9%, and 1% ± 0.6%, respectively. Sperm cells were identified in 7% and 3% of the 28 and 71 men with complete AZFb and AZFb-c and in 57% and 43% of the 14 and 7 men with partial AZFb and AZFb-c deletions, respectively. The likelihood of finding sperm cells in men with complete versus partial AZFb and AZFb-c deletions was significantly lower. As yet, no clinical or chemical pregnancy after ICSI in cases with complete AZFb/b-c microdeletions has been reported. Conclusion(s): Determining the extent of AZFb or AZFb-c deletions is critical considering the frequency and the reasonable prospect of finding sperm cells in partial AZFb/AZFb-c deletions. Referring men with complete AZFb/b-c microdeletions to testicular sperm extraction/ICSI programs should be revaluated.