Sperm retrieval rate and patient factors in AZFc microdeletion azoospermia: a systematic review

Objective To reveal the overall sperm retrieval rate and range in AZFc microdeletion azoospermic patients by microdissection testicular sperm extraction (mTESE), and discuss the differences of preoperative patient factors among studies with various sperm retrieval rate (SRR). Materials and methods We searched PubMed, Web of Science and Embase until February 2023. All studies reporting SRR by mTESE and required parameters of patients with AZFc microdeletions were included. The primary outcome was SRR and, if available, pregnancy rate (PR) and live birth rate (LBR) after intracytoplasmic sperm injection (ICSI) were also investigated as secondary outcomes. Results Eventually 11 cohort studies were included in this review. A total number of 441 patients underwent TESE and 275 of them obtained sperm, reaching an overall SRR of 62.4%. The SRRs among studies had a wide range from 25.0% to 85.7%. The studies reporting higher SRRs generally had higher mean ages, FSHs and testosterones. Only four studies provided practical data on pregnancies and live‐born children of patients with AZFc microdeletions, so the overall PR and LBR were unavailable. Conclusions The overall SRR of AZFc microdeletion azoospermic patients was around 62.4%. The effect of patient factors in sperm retrieval needs further evidence in future work.