Frequency distribution analysis revealed that 71.1% of
men (49 of 69) with OA had an AGD
‡
35. In contrast,
only 37.9% of men (11 of 29) with NOA had an
AGD
‡
35. Similarly, 8.7% of men (6 of 69) with OA
had an AGD < 30, while 41.4% of men (12 of 29) with
NOA had an AGD < 30 (Table 3). Multivariate logistic
regression analysis revealed that the odds for having
obstructive azoospermia versus nonobstructive azoosper-
mia were 5.6 (95% CI 1.0, 30.7) with an AGD < 30 mm
(Table 3).
Receiver operator characteristic curve showed that
AGD had an area under the curve of 0.66 (95% CI 0.52–
0.80). Testis size and penile size had an AUC of 0.94
(95% CI 0.89–0.99) and 0.58 (95% CI 0.45–0.72), respec-
tively. Testis size was signi±cantly more predictive of the
etiology of azoospermia compared to both AGD and PL
(
p
< 0.01 for both). Similarly, AGD was superior to PL
(
p
< 0.01).
After excluding men with obstructive azoospermia and
assessing AGD strati±ed by total motile sperm count,
there appeared to be a J shaped relationship with men
with severe oligospermia (Total motile sperm count < 2
million) having the shortest AGD (Table 4, Fig. 1). Strati-
fying men by genetic testing results (i.e. karyotype and Y
chromosome microdeletion), revealed that men with
abnormal genetic screening had shorter AGD (Table 5).
Table 1
Demographic, anthropomorphic, and hormonal characteristics of the cohort. Comparisons made using
ANOVA
for most continuous vari-
ables and chi-squared for categorical variables with relevant
p
value displayed. Hormonal comparisons made using Wilcoxon rank sum test
N
OA
NOA
Mean (SD) or %
Median (95% CI)
n
Mean (SD) or %
Median (95% CI)
Age
69
44.2 (9.2)
42.9 (31.9, 64.7)
29
32.8 (4.8)
31.2 (26.4, 41.8)
<0.01
Height
68
71.1 (2.9)
71 (67, 76)
28
69.8 (2.5)
70 (66, 74)
0.05
Weight
68
198.3 (26.0)
196.7 (155, 253.5)
28
208.9 (41.7)
200 (154, 300)
0.14
BMI
68
27.7 (3.8)
26.9 (22.3, 36.2)
28
30.2 (6.1)
29.1 (22.1, 39.2)
0.02
Race
White
65
94.2
20
69
<0.01
Black
3
4.4
6
20.7
Other
1
1.5
3
10.3
Testosterone
6
267.0 (67.4)
281 (167, 357)
20
319.6 (150.0)
268 (141, 601)
0.67
FSH
6
6.2 (5.5)
4.5 (2, 17)
20
16.7 (11.1)
14 (4.5, 39)
<0.01
LH
6
3.7 (3.2)
2 (2, 10)
16
7.6 (4.8)
6 (3, 17)
0.02
Table 2
Genital measurements of the cohort. Comparisons made using Wilcoxon rank sum test with relevant
p
value displayed
Genital measurements
OA
NOA
N
Mean (SD)
Median (95% CI)
n
Mean (SD)
Median
(95% CI)
p
Value
Anogenital distance (mm)
69
41.9 (11.3)
40 (28.6, 60.2)
29
36.3 (16.3)
31.2 (17.9, 62)
0.01
Stretched penile length (mm)
69
125.4 (20.3)
127 (102, 157)
29
123.0 (25.2)
121 (90, 165)
0.20
Total testicular volume (mL)
67
41.7 (6.2)
44 (30, 50)
29
26.4 (7.0)
28 (16, 36)
<0.01
Table 3
Test performance characteristics of AGD to distinguish etiology of azoospermia in 5 mm increments. The number (percentage) of men
who have anogenital lengths below the listed cutoff are presented. The sensitivity, speci±city, positive predictive value (PPV), negative predictive
value (NPV) are listed. The unadjusted and adjusted OR with 95% con±dence intervals are listed showing the odds that a man will have NOA
compared to OA if his AGD is below the listed cutoff. *Adjusted for age, race, and BMI. NC – not calculable
<AGD (mm)
OA
n
(%)
NOA
n
(%)
Sensitivity
Speci±city
PPV
NPV
Unadjusted
OR (95% CI)
Adjusted*
OR (95% CI)
20
0 (0)
3 (100)
10.3
100
100
72.6
NC
NC
25
1 (10)
9 (90)
31.3
98.6
90
77.3
30.6 (3.7, 256.3)
26.7 (2.1, 332.2)
30
6 (33.3)
12 (66.7)
41.4
91.3
66.7
78.8
7.4 (2.4, 22.6)
5.6 (1.0, 30.7)
35
20 (52.6)
18 (47.4)
62.1
71
47.4
81.7
4.0 (1.6, 10.0)
4.0 (0.9, 17.7)
40
34 (65.4)
18 (34.6)
62.1
50.7
34.6
76.1
1.7 (0.7, 4.1)
1.5 (0.4, 5.9)
The relationship between anogenital distance and azoospermia in adult men
M. L. Eisenberg
et al.
International Journal of Andrology
, 2012,
35
, 726–730
ª
2012 The Authors
728
International Journal of Andrology
ª
2012 European Academy of Andrology