An integrative prediction model of successful sperm retrieval for men with non-obstructive azoospermia

Microdissection testicular sperm extraction (micro-TESE) is an efficient method for obtaining spermatozoa from patients with non-obstructive azoospermia, but the overall success rate of this surgery is only approximately one-third. This study aimed to construct an integrative prediction model for andrologists to assess the preoperative success retrieval rate. A total of 217 patients diagnosed with non-obstructive azoospermia at the First Affiliated Hospital of Nanjing Medical University were included, in whom sperm was successfully retrieved in 71 patients. We retrospectively analyzed their clinical characteristics and pathological features. Single factor analysis and logistic regression analysis were utilized to validate the predictive performance, and the area under the curve (AUC) analysis was conducted to further assess the clinical diagnostic value of the model. The results showed that a history of Klinefelter syndrome or cryptorchidism, FSH (Follicle Stimulating Hormone) levels, and testicular pathology contributed differently to the nomogram prediction model. Relatively normal FSH levels, a history of Klinefelter syndrome or cryptorchidism, and favorable testicular pathological types were assigned higher scores, with higher scores often accompanying a preferable success rate of sperm retrieval. The integrated model showed good prediction performance, with an AUC (Area Under the Curve) of 0.781 (95% CI (confidence interval) 0.713-0.849). Overall, our integrative model demonstrates excellent prediction performance and may assist andrologists in balancing the benefits of surgery preoperatively.