An examination of predictive markers for successful sperm extraction procedures: a linear model and systematic review

Abstract

The authors performed a comprehensive review of current literature to create a model comparing commonly evaluated variables in male factor infertility, for example, follicle-stimulating hormone (FSH), testicular volume (TV), and testosterone (T), to better predict sperm retrieval rate (SRR). Twenty-nine studies were included, 9 with data on conventional testicular sperm extraction (cTESE) for a total of 1227 patients and 20 studies including data on microdissection testicular sperm extraction (mTESE) for a total of 4760 patients. A weighted-means value of SRR, FSH, T, and TV was created, and a weighted linear regression was then used to describe associations among SRR, type of procedure, FSH, T, and TV. In this study, weighted-means values demonstrated mTESE to be superior to cTESE with an SRR of 51.9% vs 40.1%. Multiple weighted linear regressions were created to describe associations among SRR, procedure type, FSH, T, and TV. The models showed that for every 1.19 mIU ml −1 increase in FSH, there would be a significant decrease in SRR by 1.0%. Seeking to create a more clinically relevant model, FSH values were then divided into normal, moderate elevation, and significant elevation categories (FSH <10 mIU ml −1 , 10–19 mIU ml −1 , and >20 mIU ml −1 , respectively). For an index patient undergoing cTESE, the retrieval rates would be 57.1%, 44.3%, and 31.2% for values normal, moderately elevated, and significantly elevated, respectively. In conclusion, in a large meta-analysis, mTESE was shown to be more successful than cTESE for sperm retrievals. FSH has an inverse relationship to SRR in retrieval techniques and can alone be predictive of cTESE SRR.

Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non‐obstructive azoospermia: A systematic review and meta‐analysis

“…Recently, Major et al. conducted a multiple weighted linear regression and found that SRR decreased by 1.0% for every 1.19 mIU/mL increase in FSH 38 . Less attention has been given to the predictive value of LH for SRR, but our results showed that lower LH levels were more beneficial for sperm retrieval outcomes.…”

“…Recently, Major et al conducted a multiple weighted linear regression and found that SRR decreased by 1.0% for every 1.19 mIU/mL increase in FSH. 38 Less attention has been given to the predictive value of LH for SRR, but our results showed that lower LH levels were more beneficial for sperm retrieval outcomes. One possible reason is that high levels of gonadotropins in plasma lead to downregulation of FSH and LH receptors in Sertoli and Leydig cells, and Sertoli and Leydig cells become insensitive to gonadotropins, resulting in poor testicular spermatogenesis.…”

Our evaluation of the paper authored by Sakas

“…4 Existing meta-analyses highlight the superiority of MD-TESE over conventional TESE and percutaneous TESA in men with NOA. 5 A study by Bernie 6 included 15 studies with a total of 1890 patients; MD-TESE was compared with conventional TESE and percutaneous TESA. MD-TESE was 1.5 times more likely (95% CI 1.4-1.6) to result in more successful sperm retrieval than conventional TESE.…”

A step closer to parenthood with non‐obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single‐centre study

“…5 Studies investigating predictive factors for positive surgical sperm retrieval in NOA are far from complete Currently, there are no reliable predictive markers of sperm retrieval rate. 6 The sperm retrieval procedure microdissection testicular sperm extraction (MD-TESE) is the gold standard for sperm retrieval in NOA 7 men but combined with in vitro fertilisation (IVF) comes at a significant cost. It has been estimated that only 30% of studies investigating NOA report live birth rates (LBRs), 8 leaving a significant gap in counselling couples with NOA about their realistic chance of taking home a baby once the diagnosis is confirmed.…”