Human chorionic gonadotrophin treatment prior to microdissection testicular sperm extraction in non-obstructive azoospermia  

Oleh:

Shiraishi, Koji ; Ohmi, Chietaka ; Shimabukuro, Tomoyuki ; Matsuyama, Hideyasu

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Human Reproduction vol. 27 no. 02 (Feb. 2012), page 331-339.
Topik: Non-Obstructive Azoospermia; Microdissection Testicular Sperm Extraction; Hormonal Therapy

Ketersediaan

Perpustakaan FK Nomor Panggil: H07.K.2012.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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BACKGROUND Despite the improved success rate of sperm retrieval by microdissection testicular sperm extraction (micro-TESE), methods to stimulate spermatogenesis in men with non-obstructive azoospermia (NOA) remain unexplored. The aim of this study was to evaluate the effects of hCG-based hormonal stimulation in men with NOA on the success of sperm retrieval by micro-TESE. METHODS Forty-eight men with NOA who had negative sperm retrieval results by the micro-TESE procedure were included. A second micro-TESE was subsequently performed on these men: 20 were not treated by any hormonal therapy, and 28 subjects received daily subcutaneous injections of hCG for 4–5 months prior to the second micro-TESE. Recombinant FSH was added if endogenous gonadotrophin levels decreased during the hCG stimulation. The sperm retrieval rate at the second micro-TESE; the levels of gonadotrophins, testosterone and estradiol; and the effects of hormonal therapy on testicular histology were evaluated. RESULTS Among the 28 men with hCG stimulation, 15 (54%) showed decreased LH and FSH levels (0.67 ± 0.10 and 0.96 ± 0.14 mIU, mean ± SEM, respectively) due to elevated serum testosterone (9.5 ng/dl). Sperm were obtained at the second micro-TESE from six men who had received hormonal therapy (21%), whereas no sperm were retrieved from untreated men (P < 0.05). Success at the second micro-TESE was more likely if histology at the first micro-TESE showed hypospermatogenesis. CONCLUSIONS The Leydig cells of the testis can respond positively to exogenous hCG even under hypergonadotropic conditions. HCG-based hormonal therapy prior to a second micro-TESE attempt is effective in men with hypospermatogenesis.

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