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

• Published in: Human reproduction (Oxford) Vol. 27; no. 2; pp. 331 - 339
• Main Authors: Shiraishi, Koji, Ohmi, Chietaka, Shimabukuro, Tomoyuki, Matsuyama, Hideyasu
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2012
• Subjects: Adult; Azoospermia - blood; Azoospermia - pathology; Azoospermia - therapy; Biological and medical sciences; Chorionic Gonadotropin - administration & dosage; Chorionic Gonadotropin - adverse effects; Chorionic Gonadotropin - therapeutic use; Drug Monitoring; Drug Therapy, Combination - adverse effects; Estradiol - blood; Follicle Stimulating Hormone, Human - administration & dosage; Follicle Stimulating Hormone, Human - adverse effects; Follicle Stimulating Hormone, Human - therapeutic use; Gynecology. Andrology. Obstetrics; Humans; Luteinizing Hormone - blood; Male; Male genital diseases; Medical Records; Medical sciences; Microdissection; Middle Aged; Non tumoral diseases; Premedication; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Retrospective Studies; Sperm Retrieval; Spermatogenesis - drug effects; Testis - drug effects; Testis - pathology; Testis - surgery; Testosterone - blood; Young Adult; hormonal therapy; non-obstructive azoospermia; microdissection testicular sperm extraction; Human chorionic gonadotrophin; Azoospermia; Testicular sperm extraction; Treatment; Microdissection; Male sterility; Gonadotropin; Male genital diseases; Placental hormone
• ISSN: 0268-1161; 1460-2350; 1460-2350
• DOI: 10.1093/humrep/der404

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.