A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study

Boitrelle, Florence; Robin, Geoffroy; Marcelli, F.; Albert, Martine; Leroy‐Martin, B.; Dewailly, Didier; Rigot, Jean-Marc; Mitchell, Valérie

doi:10.1093/humrep/der314

Cited by 82 publications

(68 citation statements)

References 38 publications

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“…Since thresholds for inhibin B and FSH together were associated with a greater OR than the threshold for the individual hormones alone, the measurement of inhibin B might substantially increase the predictive power of FSH. In fact, the combined use of FSH and inhibin B has proved to be of particular value in azoospermic conditions (13,35).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

The serum inhibin B concentration and reference ranges in normozoospermia

Barbotin

Ballot

Sigala

et al. 2015

European Journal of Endocrinology

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Objective: Although an inhibin B assay may be useful in the assessment of testicular function in a number of genital conditions, reliable reference ranges are still lacking. The present study sought to establish the reference range for serum inhibin B by applying the updated Gen II assay. Design: This prospective study included 818 men referred for semen analysis: 377 were normozoospermic (reference group) and 441 presented at least one abnormal semen parameter (case group). Methods: Semen parameters were interpreted according to the 2010 World Health Organization manual and David's modified classification for normal morphology. The inhibin B concentration was determined with the current ELISA. Results: In the reference group, the 2.5th percentile for inhibin B was 92 pg/ml and the 97.5th percentile for FSH was 7.8 IU/l. In the overall population, an inhibin B level !92 pg/ml was associated with increased odds ratio (OR; 95% CI) for oligozoospermia (16.93 (9.82-29.18), P!0.0001), asthenozoospermia (4.87 (2.88-8.10), P!0.0001), and teratozoospermia (2.20 (1.31-3.68), PZ0.0026). The combination of a FSH O7.8 IU/l and an inhibin B !92 pg/ml was associated with greater OR for oligozoospermia (98.74 (23.99-406.35), P!0.0001) than for each hormone considered separately. Conclusions: A new reference range for serum inhibin B was established by the use of updated immunoassay. The correlations between hormone levels and semen parameters highlighted the importance of establishing these values with respect to the spermogram. When combined with FSH assay, the inhibin B range may be of value in the evaluation of spermatogenesis in a number of male genital conditions.

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

The serum inhibin B concentration and reference ranges in normozoospermia

Barbotin

Ballot

Sigala

et al. 2015

European Journal of Endocrinology

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“…More recently, a couple of studies modeled a combination of some preoperative clinical parameters in the effort of achieving an higher diagnostic accuracy: Boitrelle et al [5] calculated a score from the combination of serum FSH and inhibin B levels plus testicular volume in patients undergoing conventional testicular sperm extraction (cTESE) obtaining an area under curve (AUC) value of 0.66, while Ramasamy and coworkers used an artificial neural network and were able to identify patients with or without testicular spermatozoa retrieved by microdissection testicular sperm extraction (microTESE) with a 60.8 % diagnostic accuracy [6]. Both models did not take into account testicular histology as potential predictive factor for sperm retrieval success, as they considered only pre-clinical, non invasive parameters.…”

Section: Introductionmentioning

confidence: 99%

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Caroppo¹,

Colpi

Gazzano

et al. 2016

J Assist Reprod Genet

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Purpose The present study sought to determine the diagnostic accuracy of FSH level, testicular volume, and testicular histology in predicting the successful sperm retrieval (SSR) in a large cohort of patients with non-obstructive azoospermia undergoing conventional testicular sperm extraction (TESE). Methods We retrospectively evaluated 356 patients with nonobstructive azoospermia between June 2004 and July 2009. Binary logistic regression was used to evaluate the diagnostic accuracy of our predicting model, identifying sperm retrieval rate as binary dependent variable. The predictive accuracy of all variables individually evaluated was quantified with area under curve (AUC) estimates derived from receiver operating characteristic (ROC) curve.Results The mean patients' age was 36.8 years. Testicular sperm were retrieved in 158 out of 356 patients (44.3 %). Histological diagnosis of Sertoli cell only syndrome (SCO) was obtained in 216 patients (60.6 %), while 55 patients (15.4 %) had maturation arrest (MA) and 85 (23.8 %) had hypospermatogenesis (HYPO). The binary logistic regression model was statistically significant (χ 2 = 96.792, p < 0.0001) and correctly classified 72.8 % of cases with 46.8 % sensitivity and 93.4 % specificity, positive predictive value (PPV) 85.06 %, negative predictive value (NPV) 68.7 %, +likelihood ratio (LR) 7.13, and −LR 0.57. Only testicular histology was significant to the model, while FSH and testicular volume were not. Sperm retrieval rate (SRR) was significantly higher in patients with HYPO compared to patients with SCO or MA (88.2 vs 30.5 and 30.9 %, respectively, p < 0.0001) Conclusions This study demonstrates that including testicular histology in a model for predicting sperm retrieval increases its diagnostic accuracy. As histology is not available prior to TESE, this model applies only to patients with previous testicular surgery.

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“…These men may be those with anticipated poor prognosis such that our study has included those with 'better' prognosis and therefore a higher sperm retrieval rate. In addition, while some authors suggest that hormonal profile or testicular volume may have provided prognostic information, 35,36 our information on hormonal profile of men was incomplete. Prior to TESE, FSH might have been checked up to 2 years because of the long waiting list for IVF, and therefore was not analysed in this study.…”

Section: Discussionmentioning

confidence: 93%

“…33 Seminal anti-Müllerian hormone and inhibin B are secreted by the Sertoli cells into the seminiferous tubules and therefore in theory are more direct markers of spermatogenesis, but their predictive value for successful TESE was not confirmed in a prospective study of 139 men with NOA by Mitchell et al 34 A combination of factors have been shown to fare better, and authors have described the use of a predictive score involving the total testicular volume, FSH, and inhibin B to predict the sperm retrieval rate in NOA. 35 There are several limitations to our study. The number of men who declined genetic testing or TESE was not known.…”

Section: Discussionmentioning

confidence: 94%

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Chai

Lee

et al. 2016

Hong Kong Med J

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Objective: There are currently no local data on the sperm retrieval and pregnancy rates in in-vitro fertilisation and testicular sperm extraction cycles, especially with regard to the presence of genetic abnormalities. This study aimed to determine the sperm retrieval and pregnancy rates in infertile couples who underwent in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia.Methods: This retrospective case series was conducted at a tertiary assisted reproduction unit in Hong Kong. Men with non-obstructive azoospermia who underwent in-vitro fertilisation and testicular sperm extraction between January 2001 and December 2013 were included. The main outcome measures were sperm retrieval and pregnancy rates.Results: During the study period, 89 men with non-obstructive azoospermia underwent in-vitro fertilisation and testicular sperm extraction. Sperm was successfully retrieved in 40 (44.9%) men. There was no statistically significant difference in the sperm retrieval rate of those with karyotypic abnormalities (2/5, 40.0% vs 28/61, 45.9%; P=1.000) and AZFc microdeletion (3/6, 50.0% vs 28/61, 45.9%; P=1.000) compared with those without. Sperms were successfully retrieved in patients who had mosaic Klinefelter syndrome (2/3, 66.7%) but not in the patient with non-mosaic Klinefelter syndrome. No sperms were found in men with AZFa or AZFb microdeletions. Pregnancy test was positive in 15 (16.9%) patients and the clinical pregnancy rate was 13.5% (12/89) per cycle. The clinical pregnancy rate Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for nonobstructive azoospermia in Hong KongNew knowledge added by this study • Our study provides important local data for counselling of men with non-obstructive azoospermia. The sperm retrieval rate and clinical pregnancy rate per cycle in men undergoing in-vitro fertilisation and testicular sperm extraction in our unit were 44.9% and 13.5%, respectively.• There was no statistically significant difference in the sperm retrieval and pregnancy rates in those with karyotypic abnormalities and AZFc microdeletion compared with those without. Sperms, however, were not found in men with AZFa or AZFb microdeletions. Implications for clinical practice or policy • Although karyotype abnormalities and AZFc microdeletion did not affect the sperm retrieval and pregnancy rates in couples undergoing in-vitro fertilisation and testicular sperm extraction, karyotype and Y-microdeletion should be checked in men with non-obstructive azoospermia. The risk of vertical transmission of genetic abnormalities should be discussed and couples should be offered appropriate genetic counselling before treatment.

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A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study

Abstract: Thanks to better knowledge of TESE quality, the present score could help to improve care and pre-ICSI counseling for patients with NOA.

Cited by 82 publications

References 38 publications

The serum inhibin B concentration and reference ranges in normozoospermia

The serum inhibin B concentration and reference ranges in normozoospermia

Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

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