Systemic immune-inflammation index, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are predictors of sperm presence in microdissection testicular sperm extraction

Clinical predictors of successful outcomes for couples with nonobstructive azoospermic male partners undergoing micro-TESE

ABSTRACT

Nonobstructive azoospermia (NOA) is the most challenging and complex clinical scenario for infertile men. Besides circumstances such as hypogonadotropic hypogonadism, surgical sperm retrieval is typically necessary, and microdissection testicular sperm extraction (micro-TESE) is the procedure of choice for men with NOA desiring to father children with their own gametes. Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection (ICSI) in comparison to all other techniques for surgical sperm retrieval in men with NOA. Several factors may affect sperm retrieval rate and ICSI outcomes, including the patient's age, testicular volume, histopathological and genetic profile, and serum hormone levels. This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.

Association between systemic immune inflammation index and serum testosterone and free testosterone in middle-aged and elderly men

BACKGROUND

Chronic inflammation is a pervasive feature of aging and may be associated with testosterone in middle-aged and older men. Systemic immune-inflammation index (SII) is a novel inflammatory biomarker. We aimed to assess the association between SII and serum testosterone and free testosterone (FT) in middle-aged and older men.

METHODS

Our study included males ≥ 40 years old in the 2011-2016 and 2021-2023 National Health and Nutrition Examination Survey. Multivariable regression analysis was used to explore the associations between SII and serum testosterone and FT in middle-aged and older men. Subgroup analysis was performed according to age.

RESULTS

About 5354 participants were included, of which 2450 contained FT data. Multivariable linear regression found that SII exhibited an inverse association with serum testosterone (β -0.05, 95% CI -0.07 to -0.03, P < 0.001) and FT (β -0.03, 95% CI -0.05 to -0.01, P = 0.032) in middle-aged and elderly men. After SII was grouped as quartiles, serum testosterone was significantly lower in SII quartile 4 than in SII quartile 1 (β -0.05, 95% CI -0.08 to -0.02, P < 0.001). However, FT was not significantly lower in SII quartile 4 than in SII quartile 1 (β -0.03, 95% CI -0.07 to 0.01, P = 0.135). In subgroup analysis, the serum testosterone results were consistent with the overall results. However, only in the ≥60 years group, SII exhibited an inverse association with FT (β -0.06, 95% CI -0.1 to -0.02, P = 0.002) and was significantly lower in SII quartile 4 than in SII quartile 1 (β -0.06, 95% CI -0.12 to -0.01, P = 0.049).

CONCLUSIONS

Our study revealed an inverse association between SII and serum testosterone and FT in middle-aged and elderly men, particularly among men ≥ 60 years.

Role of Follicle-stimulating Hormone, Inhibin B, and Anti-Müllerian Hormone in Predicting Sperm Retrieval from Men with Nonobstructive Azoospermia Undergoing Microdissection Testicular Sperm Extraction: A Systematic Review and Meta-analysis

Background and objective

No clear-cut markers for predicting positive sperm retrieval (+SR) at microdissection testicular sperm extraction (mTESE) have been identified thus far. Our aim was to conduct a systematic review and meta-analysis to evaluate the ability of follicle-stimulating hormone (FSH), inhibin B (InhB), and anti-Müllerian hormone (AMH) to predict +SR in men with nonobstructive azoospermia (NOA) undergoing mTESE.

Methods

We performed a search in the PubMed, EMBASE, Web of Science, and Scopus databases according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Thirty-four publications were selected for inclusion in the analysis.

Key findings and limitations

Overall, the mean +SR rate was 45%. Pooled standardized mean difference (SMD) values revealed significant hormonal differences between the +SR and -SR groups, with lower FSH (SMD -0.30), higher InhB (SMD 0.54), and lower AMH (SMD -0.56) levels in the +SR group. Pooled odds ratios (Ors) revealed no significant prediction of +SR by either FSH (OR 1.03, 95% confidence interval [CI] 1.00-1.06) or InhB (OR 1.01, 95% CI 1.00-1.02), despite variations in baseline levels and study heterogeneity. Conversely, AMH had significant predictive value (OR 0.82, 95% CI 0.73-0.92), with lower baseline levels in the +SR group. InhB and FSH levels were higher in the +SR group, while InhB exhibited the opposite trend.

Conclusions and clinical implications

Despite study heterogeneity, our meta-analysis findings support the ability of AMH to predict +SR for men with NOA undergoing mTESE.

Patient summary

We conducted a review and analysis of results from previous studies. Our findings show that for men with an infertility condition called nonobstructive azoospermia, blood levels of anti-Müllerian hormone can predict successful extraction of sperm using a microsurgical technique. Levels of two other hormones did not predict successful sperm extraction.

A dual-center study of predictive factors for sperm retrieval through microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in men with non-mosaic Klinefelter syndrome

PURPOSE

This study evaluated the predictors of sperm retrieval (SR) in non-mosaic Klinefelter syndrome (KS) patients undergoing microsurgical testicular sperm extraction (mTESE). The cutoff values of the predictors of SR and overall pregnancy rates after intracytoplasmic sperm injection (ICSI) were analyzed for the positive SR (PSR) cases.

MATERIALS AND METHODS

The study was a dual-center retrospective study. Overall 118 patients with KS underwent mTESE between January 2011 and July 2021. Clinicopathological factors including comorbidities, endocrine profiles, and testicular volumes were analyzed.

RESULTS

A total of 58 patients showed PSR (49.2%) and 60 patients (50.8%) had negative SR (NSR). The mean overall age of the patients was 32.5 years. The NSR patients had a significantly greater prevalence of obesity, diabetes mellitus, and cerebrovascular disease. The PSR group had a significantly higher left testis mean volume (p=0.039). The differences between the two study groups regarding follicular-stimulating hormone, luteinizing hormone, and testosterone variations at 1 and 3 months after mTESE were insignificant. Preoperative mean neutrophil-to-lymphocyte ratio was significantly greater in the NSR group (p=0.011), but the platelet-to-lymphocyte ratio showed no significant difference between the two study groups. A live child birth was achieved in 53.4% of the PSR patients. Multivariate logistic analysis showed that total testicular volume >3.93 mL, left testis volume >1.79 mL, and neutrophil-to-lymphocyte ratio ≤1.82 were significantly associated with PSR.

CONCLUSIONS

mTESE-ICSI is a feasible method for KS patients to have a child, and total testicular volume, left testis volume, and neutrophil-to-lymphocyte ratio might be predictors of successful SR.