Establishing reference values for age-related spermatogonial quantity in prepubertal human testes: a systematic review and meta-analysis

A meta-analysis of literature data on numbers of spermatogonia per tubular cross-section and spermatogonial density in the testes of age-grouped healthy boys resulted in clinical reference values throughout prepubertal life.

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Volume 106, Issue 7, Pages 1652-1657


Ieva Masliukaite, M.Sc., Julie M. Hagen, M.D., Kirsi Jahnukainen, M.D., Ph.D., Jan-Bernd Stukenborg, Ph.D., Sjoerd Repping, Ph.D., Fulco van der Veen, M.D., Ph.D., Madelon van Wely, Ph.D., Ans M.M. van Pelt, Ph.D.



To collect published data on spermatogonial quantity in the testes of healthy children and calculate the reference values of spermatogonial quantities throughout prepuberty.


Systematic literature search in PubMed and EMBASE focusing on the number of spermatogonia per transverse tubular cross section (S/T) and spermatogonial density per cubic centimeter (cm3) of testicular volume (S/V) throughout prepuberty.







Main Outcome Measure(s)

Polynomial meta-regression analyses of S/T and S/V of healthy boys from the ages of 0 to 14 years.


We found six papers describing original quantitative data on S/T and S/V of healthy boys (total n = 334 and 62, respectively) that were suitable for meta-analysis. Polynomial meta-regression analyses of S/T and S/V demonstrated a clear pattern of spermatogonial quantity throughout prepubertal life. This consisted of a decline during the first 3 years of life, a gradual increase until the ages of 6 to 7 years, a plateau until the age of 11 years, and a sharp incline reaching pubertal numbers at 13 to 14 years of age. The association between S/T and S/V allowed us to perform S/T to S/V extrapolation, creating reference S/V (rS/V) values throughout prepubertal life from a cohort of 372 boys.


Spermatogonial quantity varies during testicular development toward puberty. The values found in this study may serve as a baseline clinical reference to study the impact of diseases and adverse effects of gonadotoxic treatments on spermatogonial quantity in prepubertal testes. Spermatogonial quantity reference values may also help to evaluate the quality of testicular biopsy samples acquired for fertility preservation of prepubertal boys.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility┬« is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Mary Samplaski
almost 5 years ago
This is useful information for our patients. I would be interested to take this one step further and know if there were any physical indicators of the transition to an active spermatogenic state, and of these, which is the most specific indicator.