The Value of Composite Measurements of Extracellular Matrix Protein1, Testis- Expressed Gene 101, And Lectin Galactoside-Binding Protein in Predicting Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia

Abstract

Background: The absence of spermatozoa in the ejaculate (azoospermia) is identified in 15% of infertile men and can be classified as obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). OA and NOA are managed by specific medical and/or surgical options. Two highly promising biomarkers for male infertility are testis expressed protein (TEX101) (a protein exclusive to testicular germ cells) and epididymis-expressed protein (ECM-1) (a protein found in the extracellular matrix).  

Aim: To investigate the relationship between the individual value, as well as the composite measurements of ECM1, TEX 101 and Lectin galactoside-binding soluble 3 binding protein (LAGALS3BP) in predicting surgical sperm retrieval in men with NOA

Methods: We conducted a cross section analytical study which included Azoospermia patients who were scheduled for testicular sperm extraction (TESE). We collected essential clinical data including etiology of azoospermia, physical examination for the secondary sex characters, presence of the vas deferens, and clinical varicocele. Hormonal assessment included (FSH, LH, and Testosterone). Primary outcomes included calculating the cut-off level of the following markers ECM, TEX 101 and LAGALS3BP.

Results: We found that FSH was significantly higher among patients with TESE findings with p value 0.045, while LH, prolactin, total testosterone, free testosterone, and estrogen levels showed no statistically significant differences according to TESE outcomes. We found that LGALS3BP and TEX101 were significantly higher among patients with TESE positive findings compared to TESE negative group. LGALS3BP and TEX101 were positively and moderately correlated with TESE outcomes. We found that ECM-1 was negatively correlated with TESE outcomes with r= -0.225 and p value= 0.035. LGALS3BP level was significantly higher among patients with Hypo spermatogenesis, normal Spermatogenesis compared to Tubular Hyalinization, SCO, maturation arrest, and mixed Pathology.

Conclusion: We finally concluded that Semen biomarkers TEX 101, and LGALS3BP are reliable, sensitive, non-invasive, and cost-effective investigation that can predict outcomes of TESE.