1 3 Int Urol Nephrol DOI 10.1007/s11255-014-0856-1 UROLOGY - ORIGINAL PAPER Assessment of testicular perfusion prior to sperm extraction predicts success rate and decreases the number of required biopsies in patients with non-obstructive azoospermia Mohammad Reza Nowroozi · Mohsen Ayati · Erfan Amini · Kayvan Radkhah · Hassan Jamshidian · Asieh Delpazir · Faeze Ghasemi · Alireza Rajabzadeh Kanafi Received: 24 May 2014 / Accepted: 3 October 2014 © Springer Science+Business Media Dordrecht 2014 to direct biopsies to specific sites and subsequent decrease in the number of required biopsies. Keywords Azoospermia · Infertility · Male · Sperm retrieval · Testis · Ultrasonography · Doppler Introduction Improvements in the field of assisted reproduction and testicular sperm retrieval (SR) have enabled infertile men with azoospermia and non-obstructive testicular failure to father their own genetic children [1]. Men with azoo- spermia either obstructive (OA) or non-obstructive (NOA) are candidates for surgical sperm extraction. There have been several attempts to decrease the morbidity of the pro- cedure and increase the likelihood of SR [2, 3]. Presence of small foci of spermatogenesis in the testis of patients with NOA necessitates multiple samplings which may jeopard- ize tissue vascularity and requires prolonged search for viable sperm. Multiple biopsies of testicular tissue may lead to considerable tissue loss and androgen deficiency [4]. Therefore, extensive research efforts have been focused on developing strategies to determine testicular areas that are likely to contain spermatogenesis foci [5–7]. Localiz- ing areas with higher probability of spermatogenesis may decrease the number of required biopsies, preserving tes- ticular tissue and increase the likelihood of successful sperm extraction. Testicular perfusion has been postulated to be associ- ated with testicular tubular function and spermatogenesis focus. Testicular perfusion may also predict SR success rate [8]. Blood is supplied to the testis by testicular artery that arises from abdominal aorta and enters the tunica albuginea at posterior aspect. Branches of testicular artery Abstract Objectives To assess the role of power and color Doppler ultrasonography (US) in patients with azoospermia prior to testicular sperm extraction. Methods One hundred and thirty consecutive patients with azoospermia were assessed in this prospective study. Based on a semiquantitative method, the results of power Doppler US were graded into three categories: grade 1, no visible vessels; grade 2, between one and three detectable vessels; grade 3, more than three detectable vessels. The location of each visible vessel was also recorded as upper, middle or lower third of the testis. Results Seventy-four patients with non-obstructive azoo- spermia (NOA) and 27 with obstructive azoospermia (OA) fulfilled the study criteria. OA patients revealed a signifi- cantly higher intratesticular perfusion compared with NOA patients. NOA patients with higher intratesticular perfu- sion required fewer biopsies for successful sperm retrieval. Moreover, a correlation was noted between the presence of visible vessels in each segment and the probability of suc- cessful sperm retrieval during biopsy from the correspond- ing segment. Conclusions Our data indicate that a semiquantitative, simplified power Doppler US assessment is capable of localizing areas containing viable sperm with the potential M. R. Nowroozi (*) · M. Ayati · E. Amini · K. Radkhah · H. Jamshidian · A. Delpazir · F. Ghasemi · A. Rajabzadeh Kanafi Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran e-mail: mrnowroozi@tums.ac.ir M. R. Nowroozi Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran