Serum hormones in patients with nonobstructive azoospermia after microdissection testicular sperm extraction

Microdissection testicular sperm extraction combined with intracytoplasmic sperm injection is currently used to treat infertility in cases of nonobstructive azoospermia. Even in patients with nonmosaic Klinefelter's syndrome, who usually present with small testes and hypogonadism, the procedure has been done successfully. We assessed serum hormones after microdissection testicular sperm extraction and compared postoperative testicular damage between 46XY males with nonobstructive azoospermia and those with Klinefelter's syndrome.

We retrospectively reviewed the records of 140 men with azoospermia, including 100 46XY males with nonobstructive azoospermia and 40 with nonmosaic Klinefelter's syndrome, who underwent microdissection testicular sperm extraction. Serum follicle-stimulating hormone, luteinizing hormone and testosterone were evaluated before, and 1, 3, 6, 9, 12 and 18 months after surgery.

In 46XY males with nonobstructive azoospermia serum follicle-stimulating hormone during 18 months of followup, and luteinizing hormone 1 and 3 months postoperatively were significantly increased vs baseline. No significant differences were observed in testosterone at any postoperative time point vs baseline. In men with Klinefelter's syndrome who underwent sperm extraction mean testosterone significantly decreased an average of 30% to 35% vs baseline when assessed 1, 3, 6, 9 and 12 months postoperatively. It returned to 75% of the preoperative level after 18 months. In Klinefelter's syndrome cases no significant differences were observed in follicle-stimulating hormone and luteinizing hormone at each postoperative time point.

Hormonal followup after microdissection testicular sperm extraction is recommended, particularly in patients with Klinefelter's syndrome, to prevent the deleterious consequences of hypogonadism.