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Li JP, Du CQ, Liu ZB, Zhang FB, Li LJ, Wu JG, Tian YH, Liang ZY, Chen C, Jin F. Development and validation predictive models of sperm retrieval for azoospermic men undergoing testicular sperm aspiration: a multicentre, retrospective, cohort study. J Assist Reprod Genet 2022; 39:1779-1787. [PMID: 35870097 PMCID: PMC9428087 DOI: 10.1007/s10815-022-02531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/26/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Testicular sperm aspiration (TESA) is widely used to retrieve sperm from testis. Diagnostic testicular biopsy should not be routinely performed for azoospermia. Therefore, a good predictive model is needed before TESA. METHODS A total of 1972 azoospermia patients constituted the modelling set, and 260 azoospermia patients from two other centres constituted the validation set. An integrated predictive model was built using logistic regression. Receiver operating characteristic (ROC), calibration and decision curve analyses were performed to evaluate the performance of follicle-stimulating hormone (FSH), semen volume, testicular volume and the integrated model. RESULTS The FSH level was the best univariate predictor for successful sperm retrieval (SSR) and was better than semen volume and testicular volume alone (p<0.001, threshold 6.17 IU/L, modelling set area under receiver operating characteristic curve (AUC) 0.80, accuracy 0.79; validation set AUC 0.87, accuracy 0.78). The integrated predictive model had excellent accuracy for predicting SSR (modelling set: AUC 0.93, accuracy 0.89; validation set: AUC 0.96, accuracy: 0.89). Calibration curve analysis indicated that the integrated model calibration was good and better than that of FSH, semen volume and testicular volume alone. Decision curve analysis indicated with a threshold probability between 0.05 and 0.98, the integrated model added more benefit than treating either all or no patients. CONCLUSIONS The integrated model has excellent discrimination and good calibration. It can help azoospermic men make better decisions before TESA. It should be noted that TESA is not the first-line treatment for non-obstructive azoospermia because of a low sperm retrieval rate.
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Affiliation(s)
- Jing-Ping Li
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Cong-Qi Du
- grid.13402.340000 0004 1759 700XReproductive Medicine Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Zu-Bo Liu
- grid.513202.7Reproductive Medicine Centre, Jinhua People’s Hospital, Jinhua, People’s Republic of China
| | - Feng-Bin Zhang
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Le-Jun Li
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Jing-Gen Wu
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Yong-Hong Tian
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Zhong-Yan Liang
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
| | - Chong Chen
- grid.13402.340000 0004 1759 700XDepartment of Ultrasound, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Fan Jin
- grid.13402.340000 0004 1759 700XDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China 310006
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