Abstract
Several prediction models for successful sperm retrieval (SSR) in patients with azoospermia due to spermatogenic dysfunction (also termed non-obstructive azoospermia—NOA) have been developed and published in the past years, however their resulting prediction accuracy has never been strong enough to translate their results in the clinical practice. This notwithstanding, the number of prediction models being proposed in this field is growing. We have reviewed the available evidence and found that, although patients with complete AZFc deletion or a history of cryptorchidism may have better probability of SSR compared to those with idiopathic NOA, no clinical or laboratory marker is able to determine whether a patient with NOA should or should not undergo microdissection testicular sperm extraction (mTESE) to have his testicular sperm retrieved. Further research is warranted to confirm the utility of evaluating the expression of noncoding RNAs in the seminal plasma, to individuate patients with NOA with higher probability of SSR.
Highlights
Prediction models are widely used in the clinic to estimate the risk of existing disease or outcome for an individual, determined by the possible values of one or more predictors
Since the ability to predict such an outcome would allow the urologist to individuate those patients who are suited for microdissection testicular sperm extraction, several prediction models have been developed to date, their resulting prediction accuracy was never strong enough to translate their results to the clinical practice
Some prediction models of successful sperm retrieval have evaluated the predictive ability of clinical conditions that may be involved in the etiology of NOA (Klinefelter’s syndrome, Y chromosome microdeletions, cryptorchidism, varicocele), or may represent putative prognostic factors of microdissection testicular sperm extraction (mTESE) success
Summary
Prediction models are widely used in the clinic to estimate the risk (or probability) of existing disease or outcome for an individual, determined by the possible values of one or more predictors. The definition of SSR is not homogeneous among groups: ideally, SSR is defined as the retrieval of an adequate number and quality of sperm for intracytoplasmic sperm injection (ICSI); at least in some cases, the difference between successful (positive outcome) and failed sperm retrieval (negative outcome) may not always be as sharp as it should be to avoid the risk of misclassification. This notwithstanding, the number of prediction models being evaluated in this field is growing. To establish whether the current knowledge about prediction of mTESE success may justify further studies, in the present article, we will review the evidence about the predictive ability of the clinical and laboratory factors that have been previously proposed as candidate predictors of mTESE outcome
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