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

Nicholas MAJOR; K Russ EDWARDS; Kit SIMPSON; Marc ROGERS

作者: Nicholas MAJOR ¹ ; K Russ EDWARDS ¹ ; Kit SIMPSON ² ; Marc ROGERS ³
作者信息

1. Department of Urology, Medical University of South Carolina, Charleston, SC 29425, USA.
2. Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC 29425, USA.
3. Department of Urology, University of North Carolina, Chapel Hill, NC 27514, USA.
出版类型:Meta-Analysis
关键字: follicle-stimulating hormone; meta-analysis; microtesticular sperm extraction; nonobstructive azoospermia; testicular sperm retrieval
医学主题词: Humans; Male; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Infertility, Male; Linear Models; Semen; Sperm Retrieval; Spermatozoa; Testis/surgery*
来源: Asian Journal of Andrology 2023;25(1):38-42
国家China
语言:English
摘要: 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.