title: Prediction model for live birth in ICSI using testicular extracted sperm.
abstract: Which parameters have a predictive value for live birth in couples undergoing ICSI after successful testicular sperm extraction (TESE-ICSI)?
  
  
  
  Female age, a first or subsequent started TESE-ICSI cycle, male LH, male testosterone, motility of the spermatozoa during the ICSI procedure and the initial male diagnosis before performing TESE were identified as relevant and independent parameters for live birth after TESE-ICSI.
  
  
  
  In reproductive medicine prediction models are used frequently to predict treatment success, but no prediction model currently exists for live birth after TESE-ICSI.
  
  
  
  A retrospective cohort study between 2007 and 2015 in two academic hospitals including 1559 TESE-ICSI cycles. The prediction model was developed using data from one centre and validation was performed with data from the second centre.
  
  
  
  We included couples undergoing ICSI treatment with surgically retrieved sperm from the testis for the first time. In the development set we included 526 couples undergoing 1006 TESE-ICSI cycles. In the validation set we included 289 couples undergoing 553 TESE-ICSI cycles. Multivariable logistic regression models were constructed in a stepwise fashion (P < 0.2 for entry). The external validation was based on discrimination and calibration.
  
  
  
  We included 224 couples (22.3%) with a live birth in the development set. The occurrence of a live birth was associated with lower female age, first TESE-ICSI cycle, lower male LH, higher male testosterone, the use of motile spermatozoa for ICSI and having obstructive azoospermia as an initial suspected diagnosis. The area under the receiver operating characteristic (ROC) curve was 0.62. From validation data, the model had moderate discriminative capacity (c-statistic 0.67, 95% confidence interval: 0.62-0.72) but calibrated well, with a range from 0.06 to 0.56 in calculated probabilities.
  
  
  
  We had a lack of data about the motility of spermatozoa during TESE, therefore, we used motility of the spermatozoa used for ICSI after freeze-thawing, information which is only available during treatment. We had to exclude data on paternal BMI in the model because too many missing values in the validation data hindered testing. We did not include a histologic diagnosis, which would have made our data set less heterogeneous and, finally, our model may not be applicable in centres which have a different policy for the indication for performing sperm extraction. The prognostic value of the model is limited because of a low 'area under the curve'.
  
  
  
  This model enables the differentiation between couples with a low or high chance to reach a live birth using TESE-ICSI. As such it can aid in the counselling of patients and in clinical decision-making.
  
  
  
  This study was partly supported by an unconditional grant from Merck Serono (to D.D.M.B. and K.F.) and by the Department of Obstetrics and Gynaecology of Radboud University Medical Center, Nijmegen, The Netherlands, the Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands, and the Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Merck Serono had no influence in concept, design, nor elaboration of this study.
  
  
  
  Not applicable.
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands aukje.meijerink@radboudumc.nl.
authors.forename: A M
authors.initials: AM
authors.lastname: Meijerink
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Cissen
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
authors.forename: M H
authors.initials: MH
authors.lastname: Mochtar
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Fleischer
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Thoonen
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: de Melker
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands Department of Urology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Meissner
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Repping
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: D D M
authors.initials: DD
authors.lastname: Braat
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Wely
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Ramos
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000097:blood / Q000473:pathology*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D050498:Live Birth; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008954:Models, Biological; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D020554:Sperm Injections, Intracytoplasmic; D013081:Sperm Motility / Q000502:physiology*; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000473:pathology; D013737:Testis; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D013739:Testosterone; D007986:Luteinizing Hormone
keywords: ICSI; azoospermia; prediction model; pregnancy; sperm injection; sperm retrieval; testicular sperm extraction