Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

Lin, Qi; Liu, Ya P; Zhang, Nan N; Su, Yingchun

doi:10.1177/03000605211002703

Cited by 16 publications

(6 citation statements)

References 72 publications

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“…We studied factors that can predict successful sperm retrieval in men with NOA. It was determined that older men had a higher likelihood of successful sperm retrieval, consistent with a study by Ramasamy, 12 but in contrast to another studies 13 . The triad of testicular volume, FSH, and testosterone levels were not predictive of successful sperm retrieval and this finding supports previous research, 13 suggesting that the focal distribution of spermatogenesis may play a role in this phenomenon, rather than a global distribution.…”

Section: Discussionsupporting

confidence: 85%

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

Elzeiny,

Agresta,

Stevens

et al. 2024

Aust NZ J Obst Gynaeco

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BackgroundNon‐obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD‐TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling.AimsThis study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD‐TESE / intracytoplasmic sperm injection (ICSI).Materials and methodsA retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes.ResultsAmong 108 patients undergoing MD‐TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo‐spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring.ConclusionThis study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD‐TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.

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Section: Discussionsupporting

confidence: 85%

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

Elzeiny,

Agresta,

Stevens

et al. 2024

Aust NZ J Obst Gynaeco

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“…Finally, spermatozoa can be retrieved from testicular tissue in only about 50% of cases [5,6]. Some teams have aimed to identify the most predictive factors of a positive TESE, first using univariate models, followed by multivariate models and, finally, artificial intelligence, including machine learning (ML) models [7]. We conducted a scoping review on the prediction of TESE success, extended to relevant citations on PubMed (MeSH terms: TESE; prediction; non-obstructive azoospermia; machine learning; sperm).…”

Section: Introductionmentioning

confidence: 99%

“…Finally, a history of cryptorchidism and smoking status have shown inconsistent results [27][28][29]. Consequently, separately, none of these predictors has so far shown satisfactory, sufficient, and reproducible predictive performance to guide practitioners regarding the probability of TESE success and the evaluation of the benefit-risk balance [7,14,[30][31][32][33]. In addition, this surgery involves a substantial cost for some patients.…”

Section: Introductionmentioning

confidence: 99%

A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study

Bachelot¹,

Dhombres²,

Sermondade³

et al. 2023

J Med Internet Res

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Background Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. Objective The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. Methods We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. Results The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. Conclusions An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more.

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“…However, previous studies have confirmed that neither FSH nor testicular volume can be used as an independent predictor. 4 , 5 At the same time, although diagnostic testicular pathology helps predict the success rate of micro-TESE, it is difficult to use it as an independent predictor in KS patients with small testes. 6 In recent years, an increasing number of researchers have focused on the use of anti-Müllerian hormone (AMH) to evaluate male spermatogenic function and predict the outcome of sperm extraction, and a consensus for the application value of AMH has not yet been reached.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the sperm retrieval rate of microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome

Liu

Zhang

et al. 2023

Asian Journal of Andrology

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To investigate the factors affecting the sperm retrieval rate of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS), 64 patients with nonmosaic KS who underwent micro-TESE in the Center for Reproductive Medicine of Peking University Third Hospital (Beijing, China) between January 2016 and December 2017 were included in the study. Data on medical history, physical examination and laboratory examination results, and micro-TESE outcomes were collected. Patients were divided into two groups according to micro-TESE outcomes. The following factors were compared between the two groups by the Mann‒Whitney U test or Student’s t-test based on the distribution (nonnormal or normal) of the factors: age, testicular size, follicle-stimulating hormone level, luteinizing hormone level, testosterone level, and anti-Müllerian hormone level. The overall success rate of sperm retrieval was 50.0%. Correlation analysis showed that testicular volume was positively correlated with testosterone level. Using a logistic regression model, age and anti-Müllerian hormone levels were found to be better predictors for the sperm retrieval rate than the other parameters.

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Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

Cited by 16 publications

References 72 publications

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

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

A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study

Factors influencing the sperm retrieval rate of microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome

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