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

Abstract

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.

• Authors: Koji Shiraishi, Chietaka Ohmi, Tomoyuki Shimabukuro, Hideyasu Matsuyama
• Journal: Human reproduction (Oxford, England) (Hum Reprod) Vol. 27 Issue 2 Pg. 331-9 (Feb 2012) ISSN: 1460-2350 [Electronic] England
• PMID: 22128297 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Chorionic Gonadotropin
• Follicle Stimulating Hormone, Human
• Recombinant Proteins
• Testosterone
• Estradiol
• Luteinizing Hormone

Topics

• Adult
• Azoospermia (blood, pathology, therapy)
• Chorionic Gonadotropin (administration & dosage, adverse effects, therapeutic use)
• Drug Monitoring
• Drug Therapy, Combination (adverse effects)
• Estradiol (blood)
• Follicle Stimulating Hormone, Human (administration & dosage, adverse effects, therapeutic use)
• Humans
• Luteinizing Hormone (blood)
• Male
• Medical Records
• Microdissection
• Middle Aged
• Premedication
• Recombinant Proteins (administration & dosage, adverse effects, therapeutic use)
• Retrospective Studies
• Sperm Retrieval
• Spermatogenesis (drug effects)
• Testis (drug effects, pathology, surgery)
• Testosterone (blood)
• Young Adult