scholarly journals Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

2021 ◽  
Vol 10 (3) ◽  
pp. 387 ◽  
Author(s):  
Ettore Caroppo ◽  
Giovanni M. Colpi
Keyword(s):  
Current Knowledge ◽  
Hormonal Treatment ◽  
Hormonal Control ◽  
Testicular Sperm Extraction ◽  
Nonobstructive Azoospermia ◽  
Sperm Retrieval ◽  
Hormonal Stimulation ◽  
Testosterone Levels ◽  
Retrieval Rate ◽  
Standard Clinical Practice

Hormonal stimulation of spermatogenesis prior to surgery has been tested by some authors to maximize the sperm retrieval yield in patients with nonobstructive azoospermia. Although the rationale of such an approach is theoretically sound, studies have provided conflicting results, and there are unmet questions that need to be addressed. In the present narrative review, we reviewed the current knowledge about the hormonal control of spermatogenesis, the relationship between presurgical serum hormones levels and sperm retrieval rates, and the results of studies investigating the effect of hormonal treatments prior to microdissection testicular sperm extraction. We pooled the available data about sperm retrieval rate in patients with low vs. normal testosterone levels, and found that patients with normal testosterone levels had a significantly higher chance of successful sperm retrieval compared to those with subnormal T levels (OR 1.63, 95% CI 1.08–2.45, p = 0.02). These data suggest that hormonal treatment may be justified in patients with hypogonadism; on the other hand, the available evidence is insufficient to recommend hormonal therapy as standard clinical practice to improve the sperm retrieval rate in patients with nonobstructive azoospermia.

The Role of Hormone Stimulation in Men With Nonobstructive Azoospermia Undergoing Surgical Sperm Retrieval

2020 ◽  
Vol 105 (12) ◽  
pp. e4896-e4906
Author(s):  
Tharu Tharakan ◽  
Andrea Salonia ◽  
Giovanni Corona ◽  
Waljit Dhillo ◽  
Suks Minhas ◽  
...  
Keyword(s):  
Severe Form ◽  
Current Evidence ◽  
Testicular Sperm Extraction ◽  
Nonobstructive Azoospermia ◽  
Sperm Retrieval ◽  
Hormonal Stimulation ◽  
Estrogen Receptor Modulators ◽  
Biological Children ◽  
First Time

Abstract Nonobstructive azoospermia, (NOA) is the most common cause of azoospermia. NOA is characterized by hypergonadotropic hypogonadism, testicular failure, and impaired spermatogenesis. The recent development of surgical sperm retrieval techniques such as microsurgical testicular sperm extraction (mTESE) has, for the first time, allowed some men with NOA to father biological children. It is common practice for endocrine stimulation therapies such as gonadotropins, selective estrogen receptor modulators (SERMs), and aromatase inhibitors to be used prior to mTESE to increase intratesticular testosterone synthesis with the aim of improving sperm retrieval rates; however, there is currently a paucity of data underpinning their safety and efficacy. We present 2 cases of men with NOA undergoing endocrine stimulation therapy and mTESE. We also discuss the current evidence and controversies associated with the use of hormonal stimulation therapy in couples affected by this severe form of male infertility.

scholarly journals Intraoperative assessment of tubules in predicting microdissection testicular sperm extraction outcome in men with Sertoli cell-only syndrome

2018 ◽  
Vol 47 (2) ◽  
pp. 722-729 ◽  
Author(s):  
Yang Yu ◽  
Qi Xi ◽  
Ruixue Wang ◽  
Hongguo Zhang ◽  
Leilei Li ◽  
...  
Keyword(s):  
Sertoli Cell ◽  
Follicle Stimulating Hormone ◽  
Seminiferous Tubules ◽  
Testicular Sperm Extraction ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Intraoperative Assessment ◽  
Retrieval Rate ◽  
Surgical Suture ◽  
Tubule Diameter

Objective This study aimed to assess the value of measuring the tubule diameter during microdissection testicular sperm extraction (micro-TESE) in predicting outcomes in patients with Sertoli cell-only syndrome (SCOS). Methods Fifty-six consecutive patients with SCOS were included. Patients were classified into two groups on the basis of the diameter of seminiferous tubules measured against 5/0 surgical suture (≥100 µm or <100 µm). Results The sperm retrieval rate (SRR) in men with a tubule diameter ≥100 µm was significantly lower than that in those with <100 µm (3.1% vs. 25.0%). The SRR from the contralateral testis in men with a tubule diameter ≥100 µm was lower than that in those with <100 µm (0% vs. 14.3%). Men with a tubule diameter ≥100 µm had a significantly larger testis and lower follicle-stimulating hormone levels than did men with <100 µm (8.1 ± 2.4 vs. 5.3±1.8 mL, 19.9 ± 9.7 vs. 25.9 ± 7.1 mIU/mL, respectively). Conclusions The diameter of tubules is a useful predictor for a successful SRR in men with SCOS. Intraoperative assessment of homogeneous large tubules allows some men to perform a limited (superficial) contralateral micro-TESE after no spermatozoa are initially identified.

Predictive Factors for Sperm Retrieval in Males With Non-obstructive Azoospermia

2021 ◽  
Author(s):  
Wei-Hsun Hsu ◽  
Marcelo Chen ◽  
Pai-Kai Chiang ◽  
Wei-Kung Tsai ◽  
Allen W Chiu ◽  
...  
Keyword(s):  
Sertoli Cell ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Testicular Volume ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Retrieval Rate ◽  
Normal Spermatogenesis

Abstract The aim of the current study was to investigate the predictive markers for males with non-obstructive azoospermia (NOA) before they received conventional testicular sperm extraction (cTESE) or microdissection testicular sperm extraction (microTESE). Between January 2010 and December 2020, a total of 56 patients who received cTESE or microTESE surgery at the Urology department of the MacKay Memorial Hospital were included. Our univariate analysis revealed that the following parameters was associated with sperm retrieval: Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testicular volume, histopathology of maturation arrest and Sertoli cell-only. The multivariate analysis showed that Sertoli cell-only was significantly less likely to harvest spermatozoa than normal spermatogenesis (OR = 0.03 (0.002-0.42); p = 0.01). A comparison of cTESE and microTESE revealed that the overall successful sperm retrieval rate was not significantly different between the two methods (74.1% vs. 58.6, p = 0.22). This study demonstrated that lower levels of FSH, LH and prolactin, and a higher testicular volume and better histopathology were associated with a higher sperm retrieval rate in the univariate analysis. In the multivariable analysis, only Sertoli cell-only syndrome appeared to have a significantly negative effect on the successful harvesting of sperm when compared with normal spermatogenesis.

A Comparison of Models for Predicting Sperm Retrieval Before Microdissection Testicular Sperm Extraction in Men with Nonobstructive Azoospermia

2013 ◽  
Vol 189 (2) ◽  
pp. 638-642 ◽  
Author(s):  
Ranjith Ramasamy ◽  
Wendy O. Padilla ◽  
E. Charles Osterberg ◽  
Abhishek Srivastava ◽  
Jennifer E. Reifsnyder ◽  
...  
Keyword(s):  
Testicular Sperm Extraction ◽  
Nonobstructive Azoospermia ◽  
Testicular Sperm ◽  
Sperm Retrieval
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