Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China, 310006.
Reproductive Medicine Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
J Assist Reprod Genet. 2022 Aug;39(8):1779-1787. doi: 10.1007/s10815-022-02531-y. Epub 2022 Jul 23.
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.
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.
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.
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.
睾丸精子抽吸术（TESA）广泛用于从睾丸中获取精子。对于无精子症，不应常规进行诊断性睾丸活检。因此，在进行 TESA 之前需要建立一个良好的预测模型。
总共 1972 例无精子症患者构成了建模集，另外 260 例无精子症患者来自两个中心构成了验证集。使用逻辑回归建立了综合预测模型。进行了接收者操作特征（ROC）、校准和决策曲线分析，以评估卵泡刺激素（FSH）、精液量、睾丸体积和综合模型的性能。
FSH 水平是成功精子获取（SSR）的最佳单变量预测因子，优于单独的精液量和睾丸体积（p<0.001，阈值 6.17 IU/L，建模集 ROC 曲线下面积（AUC）为 0.80，准确性为 0.79；验证集 AUC 为 0.87，准确性为 0.78）。综合预测模型对预测 SSR 具有出色的准确性（建模集：AUC 为 0.93，准确性为 0.89；验证集：AUC 为 0.96，准确性为 0.89）。校准曲线分析表明，综合模型的校准良好，优于 FSH、精液量和睾丸体积单独使用。决策曲线分析表明，在阈值概率为 0.05 到 0.98 之间，综合模型比治疗所有或没有患者都能带来更多的获益。
综合模型具有出色的区分度和良好的校准性能。它可以帮助无精子症男性在进行 TESA 之前做出更好的决策。需要注意的是，由于精子获取率低，TESA 并不是非阻塞性无精子症的一线治疗方法。
