Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis

Abstract

We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (TESE) in patients with nonobstructive azoospermia (NOA). All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis: follicle-stimulating hormone (FSH), testicular volume, and testicular histopathological findings which included three patterns: hypospermatogenesis (HS), maturation arrest (MA), and Sertoli-cell-only syndrome (SCOS). If there was a threshold effect, only the area under the summary receiver operating characteristic curve (AUSROC) was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR) were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.

Figure 1

Flowchart of the study selection.

Figure 2

Methodological quality graph.

Figure 3

SROC curve for predictive value of FSH and testicular volume. (a) SROC curve for predictive value of FSH. (b) SROC curve for predictive value of testicular volume. SROC: summary receiver operating characteristic curve; FSH: follicle-stimulating hormone.

Figure 4

Predictive value of hypospermatogenesis. (a) SROC curve for predictive value of hypospermatogenesis. (b) Forest plot of DOR for predictive value of hypospermatogenesis. (c) Forest plot of sensitivity for predictive value of hypospermatogenesis. (d) Forest plot of specificity for predictive value of hypospermatogenesis. (e) Forest plot of PLR for predictive value of hypospermatogenesis. (f) Forest plot of NLR for predictive value of hypospermatogenesis. SROC: summary receiver operating characteristic curve; DOR: diagnostic odds ratio; PLR: positive likelihood ratio; NLR: negative likelihood ratio.

Figure 5

SROC curve for predictive value of maturation arrest and SCOS. (a) SROC curve for predictive value of maturation arrest. (b) SROC curve for SCOS. SROC: summary receiver operating characteristic curve; SROS: sertoli-cell-only syndrome; SCOS: Sertoli cell only syndrome.