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. 2023 Jan;41(1):81-93.
doi: 10.5534/wjmh.210198. Epub 2022 Mar 10.

Azoospermic Men with a History of Cryptorchidism Treated by Orchiopexy Have Favorable Outcomes after Testicular Sperm Extraction: A Systematic Review and Meta-Analysis

Sang Woon Kim  1 , Jongsoo Lee  1 , Tae Ho Lee  2 , Dong Suk Kim  2 , Seung-Hun Song  2 , Dae Keun Kim  3
Affiliations

Azoospermic Men with a History of Cryptorchidism Treated by Orchiopexy Have Favorable Outcomes after Testicular Sperm Extraction: A Systematic Review and Meta-Analysis

Sang Woon Kim et al. World J Mens Health. 2023 Jan.

Abstract

Purpose: This systematic review and meta-analysis investigated the sperm retrieval rate (SRR) and pregnancy rate after testicular sperm extraction in men with azoospermia and those with a history of cryptorchidism treated by orchiopexy.

Materials and methods: The SRR and clinical pregnancy rate were investigated. We performed a sub-analysis that included factors such as bilaterality, age, and idiopathic non-obstructive azoospermia (iNOA). The analysis comprised 13 studies from January 1995 to July 2021. The data sources were PubMed/MEDLINE, Embase, and the Cochrane Library included "cryptorchidism", "orchidopexy", "azoospermia", and "testicular sperm extraction".

Results: The overall mean SRR was 63.3% (95% confidence interval [CI], 57.6%-68.6%; I²=62.4%), and the overall mean clinical pregnancy rate was 30.1% (95% CI, 22.6%-38.8%; I²=69.9%). The meta-analysis comparing the SRR, there was no significant difference between patients with a history of bilateral and unilateral orchiopexy (relative risk [RR]=1.02; 95% CI, 0.89-1.16; p=0.79). Orchiopexy performed under the age of 10 years showed significantly increased SRR compared to the age of over 10 years (RR=1.25; 95% CI, 1.06-1.47; p=0.008). Azoospermic men with a history of cryptorchidism treated by orchiopexy had significantly higher SRR than iNOA (RR=1.90; 95% CI, 1.40-2.58; p<0.0001).

Conclusions: Men with azoospermia and a history of cryptorchidism treated by orchiopexy had significantly higher SRR than those with iNOA after testicular sperm extraction. Furthermore, patients who underwent orchiopexy before the age of ten years had significantly higher SRR than patients operated at an older than the age of ten years.

Keywords: Azoospermia; Cryptorchidism; Meta-analysis; Testicular sperm retrieval.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Flow chart of the search and selection of literature included in the systematic review and meta-analysis.
Fig. 2
Fig. 2. Forest plot of overall sperm retrieval rate after testicular sperm extraction for men having a history of surgically treated cryptorchidism. CI: confidence interval.
Fig. 3
Fig. 3. Forest plot of the overall clinical pregnancy rate for men having a history of surgically treated cryptorchidism. CI: confidence interval.
Fig. 4
Fig. 4. Forest plot of the sperm retrieval rate for azoospermic men with a history of orchiopexy versus azoospermic men with idiopathic non-obstructive azoospermia (iNOA). CI: confidence interval.
Fig. 5
Fig. 5. Forest plot of the sperm retrieval rate comparison for orchiopexy at age under 10 years versus orchiopexy at age over 10 years. CI: confidence interval.
Fig. 6
Fig. 6. Forest plot of the sperm retrieval rate for unilateral orchiopexy versus bilateral orchiopexy. CI: confidence interval.
Fig. 7
Fig. 7. Funnel plot for publication bias of cryptorchid azoospermia patients with a history of orchiopexy.
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