BACKGROUND Factor affecting sperm retrieval rate (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) have not been systematically evaluated. In addition, although micro-TESE (mTESE) has been advocated as the gold standard for sperm retrieval in men with NOA, its superiority over conventional TESE (cTESE) remains conflicting. OBJECTIVE AND RATIONALE The objective was to perform a meta-analysis of the currently available studies comparing the techniques of sperm retrieval and to identify clinical and biochemical factors predicting SRR in men with NOA. In addition, PRs and live birth rates (LBRs), as derived from subjects with NOA post-ICSI, were also analysed as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR derived from cTESE or mTESE in patients with NOA and their specific determinants were included. Data derived from genetic causes of NOA or testicular sperm aspiration were excluded. OUTCOMES Out of 1236 studies, 117 studies met the inclusion criteria for this study, enrolling 21 404 patients with a mean age (± SD) of 35.0 ± 2.7 years. cTESE and mTESE were used in 56 and 43 studies, respectively. In addition, 10 studies used a mixed approach and 8 studies compared cTESE with mTESE approach. Overall, a SRR per TESE procedure of 47[45;49]% (mean percentage [95% CI]) was found. No differences were observed when mTESE was compared to cTESE (46[43;49]% for cTESE versus 46[42;49]% for mTESE). Meta-regression analysis demonstrated that SRR per cycle was independent of age and hormonal parameters at enrolment. However, the SRR increased as a function of testis volume. In particular, by applying ROC curve analysis, a mean testis volume higher than 12.5 ml predicted SRR >60% with an accuracy of 86.2% ± 0.01. In addition, SRR decreased as a function of the number of Klinefelter's syndrome cases included (S = -0.02[-0.04;-0.01]; P < 0.01. I = 0.12[-0.05;0.29]; P = 0.16). Information on fertility outcomes after ICSI was available in 42 studies. Overall, a total of 1096 biochemical pregnancies were reported (cumulative PR = 29[25;32]% per ICSI cycle). A similar rate was observed when LBR was analysed (569 live births with a cumulative LBR = 24[20;28]% per ICSI cycle). No influence of male and female age, mean testis volume or hormonal parameters on both PR and LBR per ICSI cycle was observed. Finally, a higher PR per ICSI cycle was observed when the use of fresh sperm was compared to cryopreserved sperm (PR = 35[30;40]%, versus 20[13;29]% respectively): however, this result was not confirmed when cumulative LBR per ICSI cycle was analysed (LBR = 30[20;41]% for fresh versus 20[12;31]% for cryopreserved sperm). WIDER IMPLICATIONS This analysis shows that cTESE/mTESE in subjects with NOA results in SRRs of up to 50%, with no differences when cTESE was compared to mTESE. Retrieved sperms resulted in a LBR of up to 28% ICSI cycle. Although no difference between techniques was found, to conclusively clarify if one technique is superior to the other, there is a need for a sufficiently powered and well-designed randomized controlled trial to compare mTESE to cTESE in men with NOA.

中文翻译：

---

非阻塞性无精子症男性的精子恢复和ICSI结局：系统评价和荟萃分析。

背景技术尚未系统评估影响非阻塞性无精子症（NOA）患者睾丸精子提取（TESE）后精子回收率（SRR）或妊娠率（PR）的因素。此外，尽管有人主张将微TESE（mTESE）作为NOA男性精子回收的金标准，但其优于传统TESE（cTESE）的优势仍然存在矛盾。目的和理由目的是对目前可用的研究进行荟萃分析，比较精子取回技术，并确定可预测NOA男性SRR的临床和生化因素。此外，还分析了源自ICSI后NOA的受试者的PR和活产率（LBR）作为次要结果。搜索方法进行了广泛的Medline，Embase和Cochrane搜索。纳入了所有报道从NOTES患者中cTESE或mTESE得出SRR的试验及其具体决定因素。排除了由NOA或睾丸精子抽吸的遗传原因得出的数据。结果在1236项研究中，有117项研究符合该研究的纳入标准，招募了21404例平均年龄（±SD）为35.0±2.7岁的患者。cTESE和mTESE分别用于56和43个研究中。此外，有10项研究使用了混合方法，而8项研究将cTESE与mTESE方法进行了比较。总体而言，每个TESE程序的SRR为47 [45; 49]％（平均百分比[95％CI]）。将mTESE与cTESE进行比较时未观察到差异（cTESE为46 [43; 49]％，而mTESE为46 [42; 49]％）。荟萃回归分析表明，每个周期的SRR与入学时的年龄和激素参数无关。然而，SRR随睾丸体积增加而增加。特别是，通过应用ROC曲线分析，睾丸平均体积高于12.5 ml时，预测的SRR> 60％，准确度为86.2％±0.01。此外，SRR随所包括的克氏综合征病例数的减少而降低（S = -0.02 [-0.04; -0.01]； P <0.01。I= 0.12 [-0.05; 0.29]； P = 0.16）。关于ICSI后生育结局的信息可在42项研究中获得。总体而言，共报告了1096次生化妊娠（每个ICSI周期累计PR = 29 [25; 32]％）。分析LBR时，观察到的比率相似（569例活产，每个ICSI周期的累积LBR = 24 [20; 28]％）。在每个ICSI周期中，未观察到男女年龄，平均睾丸体积或激素参数对PR和LBR的影响。最后，将新鲜精子与冷冻精子的使用相比，每个ICSI周期观察到更高的PR（PR = 35 [30; 40]％，而分别为20 [13; 29]％）：但是，当累积分析了每个ICSI周期的LBR（新鲜的LBR = 30 [20; 41]％，而冷冻精子的LBR = 20 [12; 31]％）。对儿童的影响该分析表明，患有NOA的受试者的cTESE / mTESE导致SRR高达50％，将cTESE与mTESE进行比较时无差异。检索到的精子的LBR高达28％ICSI周期。尽管没有发现两种技术之间的差异，但要明确阐明一种技术是否优于另一种技术，仍需要一种功能强大且设计良好的随机对照试验来比较NOA男性的mTESE与cTESE。分别为20 [13; 29]％和20％[13; 29]％）：但是，当分析每个ICSI周期的累积LBR（新鲜的LBR = 30 [20; 41]％与冷冻精子的20 [12; 31]％）时，此结果尚未得到确认。对儿童的影响该分析表明，患有NOA的受试者的cTESE / mTESE导致SRR高达50％，将cTESE与mTESE进行比较时无差异。检索到的精子的LBR高达28％ICSI周期。尽管没有发现两种技术之间的差异，但要明确阐明一种技术是否优于另一种技术，仍需要一种功能强大且设计良好的随机对照试验来比较NOA男性的mTESE与cTESE。分别为20 [13; 29]％和20％[13; 29]％）：但是，当分析每个ICSI周期的累积LBR（新鲜的LBR = 30 [20; 41]％与冷冻精子的20 [12; 31]％）时，此结果尚未得到确认。对儿童的影响该分析表明，患有NOA的受试者的cTESE / mTESE导致SRR高达50％，将cTESE与mTESE进行比较时无差异。检索到的精子的LBR高达28％ICSI周期。尽管没有发现两种技术之间的差异，但是要明确阐明一种技术是否优于另一种技术，仍需要一种功能强大且设计良好的随机对照试验来比较NOA男性的mTESE与cTESE。对儿童的影响该分析表明，患有NOA的受试者的cTESE / mTESE导致SRR高达50％，将cTESE与mTESE进行比较时无差异。检索到的精子的LBR高达28％ICSI周期。尽管没有发现两种技术之间的差异，但要明确阐明一种技术是否优于另一种技术，仍需要一种功能强大且设计良好的随机对照试验来比较NOA男性的mTESE与cTESE。对儿童的影响该分析表明，患有NOA的受试者的cTESE / mTESE导致SRR高达50％，将cTESE与mTESE进行比较时无差异。检索到的精子的LBR高达28％ICSI周期。尽管没有发现两种技术之间的差异，但是要明确阐明一种技术是否优于另一种技术，仍需要一个功能强大且设计良好的随机对照试验来比较NOA男性的mTESE与cTESE。