A risk prediction model of sperm retrieval failure with fine needle aspiration in males with non-obstructive azoospermia

Abstract

STUDY QUESTIONCan we predict the risk of sperm retrieval failure among men with non-obstructive azoospermia (NOA) before they undergo fine needle aspiration (FNA)?SUMMARY ANSWEROur model, which includes FSH level, age and testicular volume as variables, can predict the risk of sperm retrieval failure with FNA.WHAT IS KNOWN ALREADYCombined with ICSI, testicular sperm aspiration (TESA) can enable patients with NOA to have their own genetic offspring. Nearly all reproductive medicine centres in China have applied FNA, but approximately half of patients with NOA experience testicular sperm retrieval failure. Nevertheless, the models developed to predict the likelihood of obtaining spermatozoa with testicular sperm extraction (TESE) cannot accurately predict sperm retrieval, and few of these models have been sufficiently validated.STUDY DESIGN, SIZE, DURATIONThis study involved three cohorts including 597 men with NOA. From 1 January 2015 to 31 July 2017, a retrospective cohort of 317 males with NOA who underwent FNA procedures at a university affiliated hospital were included to build a risk prediction model of sperm retrieval failure with FNA. Then, from 25 October 2017 to 31 March 2018, two prospective cohorts of 61 and 219 males with NOA from the same hospital and one other reproductive specialist hospital respectively, were recruited to validate the risk prediction model.PARTICIPANTS/MATERIALS, SETTING, METHODSAll men with NOA undergoing their first TESE procedure as part of a fertility treatment were included. The primary end-point was the presence of one or more spermatozoa (regardless of their motility) obtained with FNA. A binary multivariable logistic model was built to predict the risk of sperm retrieval failure after TESA using the dataset from the retrospective cohort. A cut-off value for risk was calculated with receiver operating characteristic (ROC) curve analysis. Two validation sets from the prospective cohort were used to validate the risk prediction model by measures including prediction accuracy and the true positive rate.MAIN RESULTS AND THE ROLE OF CHANCEA total of 327 (54.8%) males with NOA experienced sperm retrieval failure with FNA. FSH level, age and testicular volume were included in the prediction model for sperm retrieval failure risk. The model had an AUC of 82.3% (95% CI: 77.6–87.1%) and a cut-off value of 64.61% with a sensitivity of 0.677 and specificity of 0.863 for predicted risk. The predictive accuracies were 85.25 and 83.56% in the external validation sets from two centres. Specifically, 85.71 and 85.15% of NOA patients from two centres that experienced sperm retrieval failure were correctly identified using our model.LIMITATIONS, REASONS FOR CAUTIONA small proportion of males with NOA in whom sperm were successfully retrieved with FNA were misclassified; therefore, TESA techniques with higher sperm retrieval rates may be attempted in patients with high predicted risks of sperm retrieval failure rather than terminating the efforts to produce a genetic offspring. In additi...

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“…The binary logistic regression models were built for biomarkers based on the backward-selected metabolites. The area under the receiver operating characteristic (ROC) curves (AUC) were used to assess the predictive ability of models [ 10 , 32 ]. The schematic workflow of statistical analysis is listed in Figure S1 .…”

Successful Targeted Testicular Sperm Extraction Using Microsurgical Technique (microTESE) Following Fine Needle Aspiration (FNA) Mapping in a Non-Obstructive Azoospermia (NOA) Patient: A Case Report

“…The variables included in the formula were age, FSH value and testicular volume with failure risk cut-off value of 64.61%. The sensitivity and specificity of this formula was 0.677 and 0.863 respectively ( 8 ). Based on the formula, the risk of failure of our case was 79.25%, which means there was a high chance of retrieval failure.…”

“…However, the study above only mentioned the formula to be used as a risk prediction for FNA Mapping as a sperm retrieval method, not a guiding method. Moreover, the study also did not include the AZFc microdeletion when formulating the equation, thus the actual risk of sperm retrieval failure might be different ( 8 ).…”

“…Furthermore, a study conducted by Ma et al even recommended FNA Mapping to be used directly as a manner of sperm retrieval in patients with age of 35 years old or more, low Follicle-Stimulating Hormone (FSH) value, and large testicular volume. Otherwise, the chance of retrieval failure was high and microTESE without FNA Mapping was preferred ( 8 ).…”

Non-obstructive azoospermia: current and future perspectives

“…Ma et al . 99 developed a multivariable logistic model to predict the likelihood of sperm retrieval failure using TESA in NOA men. The authors reported that the predictive model had an AUC of 82.3% with a sensitivity of 0.677 and a specificity of 0.863.…”