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Salvage hormonal therapy after failed microdissection testicular sperm extraction: A multi-institutional prospective
Koji Shiraishi1, Tomomoto Ishikawa2, Noriko Watanabe3
1Department of Urology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Summary
Salvage hormonal therapy before a second microdissection testicular sperm extraction showed limited success for non-obstructive azoospermia. Differentiated cells in the testes may predict response to hormonal stimulation in these patients.
Area of Science:
- Reproductive Medicine
- Andrology
- Endocrinology
Background:
- Non-obstructive azoospermia (NOA) affects male fertility.
- Microdissection testicular sperm extraction (micro-TESE) is a surgical option for NOA.
- Salvage hormonal therapy aims to improve sperm retrieval rates in NOA.
Purpose of the Study:
- To evaluate the efficacy of human chorionic gonadotropin (hCG)-based salvage hormonal therapy.
- To assess outcomes of a second micro-TESE following hormonal treatment in men with NOA.
Main Methods:
- Multi-institutional study involving 21 men with NOA.
- Hormonal therapy included hCG and recombinant FSH for 4 months.
- Two micro-TESE procedures were performed with pathological analysis.
Main Results:
- Sperm retrieval rate in the second micro-TESE was 10% (2 out of 21 patients).
- Testicular histology in successful cases showed late maturation arrest and hypospermatogenesis.
- Patient demographics and hormone profiles did not correlate with successful sperm retrieval.
Conclusions:
- hCG-based salvage hormonal therapy has limited effectiveness for improving sperm retrieval in NOA during a second micro-TESE.
- The presence of differentiated cells (e.g., late maturation arrest, hypospermatogenesis) in testicular histology may indicate potential response to hormonal stimulation.
