Development of a predictive model and nomogram in sperm retrieval rate based on testicular pathological morphometric parameters in non-obstructive azoospermia patients - a multi-center study

Sep 29, 2026

Micro-TESE is an effective approach for retrieving sperm in men with non-obstructive azoospermia (NOA), yet the predictors of sperm retrieval rate remain unclear. This multi-center study evaluates testicular pathological morphometric parameters—tubule diameter (DT), height of spermatogenic epithelium (HSE), and basement-membrane thickness (TBM)—to identify their roles and build a predictive model and nomogram for SRR. Logistic regression and AUC assessed model performance using training and external validation cohorts.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

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Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Wang et al. Reproductive Biology and Endocrinology (2026) 24:2 [https://doi.org/10.1186/s12958-025-01433-9](https://doi.org/10.1186/s12958-025-01433-9) Reproductive Biology and Endocrinology RESEARCH Open Access Development of a predictive model and nomogram in sperm retrieval rate based on testicular pathological morphometric parameters in non-obstructive azoospermia patients: a multi-center study Hong-xiang Wang1, Jia-xi He2, Yi-min Guo2, Liang Zhou3, Si-xuan Li2, Zi-tong He2, Qi-ya Jing2, Pei-quan Wang2, Liu-qing Qu2, Jun-cheng Gao4, Guan-chen Liu5, Hai-xu Wang6, Yan-qi Yang7,8,9, Pan Ge7,8,9, Jian Zhang7,8,9, Xiao-ting Wang10*, Mo-qi Lv7,8,9*, Hai-ge Chen 1* and Dang-xia Zhou7,8,9* Abstract Background Microdissection testicular sperm extraction (micro-TESE) is an effective method to retrieve sperm from non-obstructive azoospermia (NOA) patients. However, the predictive factors for sperm retrieval rate (SRR) remain confused. The goal of our study was to identify the role of testicular pathological morphometric parameters, including diameter of tubule (DT), height of spermatogenic epithelium (HSE), and thickness of basement-membrane (TBM) in NOA patients, and to develop a predictive model and nomogram to predict SRR based on these morphometric parameters. Methods This study involved two cohorts including 406 men with NOA. A retrospective cohort of 313 males with NOA who underwent micro-TESE at Northwest Women’s and Children’s Hospital (Xi’an, China) were included to build a prediction model of SRR. Then, another retrospective cohort of 93 males with NOA from Ren Ji Hospital (Shanghai, China) were recruited to validate the prediction model. The measurement of testicular morphometric parameters as well as the assessment of Johnsen score and pathological diagnostic types were performed by at least two pathologists. Testicular volumes as well as level of serum hormones including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were also measured. Logistic regressions were used to test potential predictors of SRR. Area under curve (AUC) estimates was used to evaluate the predictive accuracy. The validation datasets were used to validate the prediction model by prediction accuracy. *Correspondence: Xiao-ting Wang [369542541@qq.com](369542541@qq.com)[ ](369542541@qq.com)[Mo-qi Lv](Mo-qi Lv)[ ](Mo-qi Lv)[lvmoqi@xjtu.edu.cn](lvmoqi@xjtu.edu.cn)[ ](lvmoqi@xjtu.edu.cn)Hai-ge Chen [rjbladder@163.com](rjbladder@163.com)[ ](rjbladder@163.com)[Dang-xia Zhou](Dang-xia Zhou) [zdxtougao@163.com](zdxtougao@163.com); [zhoudx@xjtu.edu.cn](zhoudx@xjtu.edu.cn) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/.)[.](http://creativecommons.org/licenses/by-nc-nd/4.0/.) Wang et al. Reproductive Biology and Endocrinology (2026) 24:2 Page 2 of 15 Results Our study demonstrated that DT and HS

FAQs

What was the study’s main goal regarding sperm retrieval rate (SRR)?

To identify how testicular pathological morphometric parameters (DT, HSE, TBM) influence SRR in NOA patients and to develop a predictive model and nomogram for SRR.

How were the cohorts used to build and validate the model?

A retrospective cohort of 313 NOA men undergoing micro-TESE was used to develop the prediction model, and a separate retrospective cohort of 93 NOA men from another hospital was used for external validation.

Which morphometric parameters showed positive versus negative associations with SRR?

DT and HSE were significantly associated with successful sperm retrieval and showed positive correlations with Johnsen score, testicular volume, and serum testosterone, but negative correlations with serum FSH and LH; TBM showed opposite patterns.

Sep 29, 2026

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