Anti-Müllerian Hormone as a Biomarker for Predicting Testicular Sperm Extraction Outcomes in Azoospermic Patients: A Comprehensive Systematic Review and Meta-Analysis.

Abstract

Male infertility represents a major clinical and societal issue, with azoospermia being one of its most severe forms. Anti-Müllerian Hormone (AMH) has been proposed as a potential biomarker for predicting testicular sperm extraction (TESE) outcomes in men with non-obstructive azoospermia (NOA). This study aimed to systematically evaluate the association between AMH levels and sperm retrieval success. We included studies on men with NOA reporting TESE outcomes by AMH level, excluding those without full text or with insufficient data. When cohorts overlapped, the most complete study was used, following PICO criteria focused on AMH measurements and sperm retrieval rates (SRR). A comprehensive search identified 133 potentially relevant publications. Of these, 11 studies published between 2006 and 2023, including 1280 patients, met the inclusion criteria. Pooled analyses were performed using random-effects models. This meta-analysis was recorded in the PROSPERO database (registration ID: CRD420251065256). Reported SRRs ranged from 30.35% to 76.27%. Meta-analysis of nine studies assessing serum AMH concentrations revealed significant heterogeneity (I² = 88%). Elevated serum AMH was negatively associated with SRR (standardized mean difference [SMD] = -2.58; 95% CI: -4.73 to -0.44; <i>p</i> < 0.00001). In contrast, seminal plasma AMH levels (two studies) showed no significant association with SRR (I² = 82%). Similarly, preoperative FSH levels (nine studies) did not demonstrate a consistent association with SRR, despite higher mean concentrations in patients with successful TESE (<i>p</i> = 0.02; SMD = -4.86; 95% CI: -9.07 to -0.66). Serum AMH levels are significantly associated with TESE outcomes in men with NOA. However, the predictive value of AMH and other hormonal markers is limited by high inter-individual variability and overlapping values between successful and unsuccessful cases. These findings underscore the complexity of NOA and highlight the need to interpret hormonal markers within a broader clinical and biochemical context.