Micro-TESE in Non-Obstructive Azoospermia: Phenotype-Guided Hormonal Optimization and Testosterone...

Area of Science:

• Reproductive Endocrinology
• Male Infertility Research
• Spermatogenesis Studies

Background:

• Non-obstructive azoospermia (NOA) is a severe form of male infertility due to impaired sperm production.
• Microdissection testicular sperm extraction (micro-TESE) is the main surgical method for sperm retrieval in NOA, with variable success rates (40-60%).
• Preoperative hormonal optimization is explored to improve micro-TESE outcomes.

Purpose of the Study:

• To review guidelines and evidence on preoperative hormonal optimization for NOA.
• To investigate the role of endogenous testosterone dynamics in sperm retrieval.
• To evaluate hormonal therapies in relation to sperm retrieval rates and success in NOA.

Main Methods:

• Narrative review of international and regional guidelines.
• Synthesis of contemporary evidence on hormonal pretreatment for NOA.
• Analysis of endocrine phenotypes and testosterone dynamics in relation to micro-TESE outcomes.

Main Results:

• Exogenous testosterone is contraindicated in men seeking fertility.
• Hormonal agents like SERMs, AIs, hCG, and FSH may support Leydig and Sertoli cell function.
• Low-certainty evidence suggests hormonal pretreatment may increase sperm retrieval in selected normogonadotropic/hypogonadal men, but not consistently in hypergonadotropic NOA.
• A greater testosterone rise during stimulation correlates with retrieval, possibly indicating Leydig cell reserve.

Conclusions:

• Preoperative endocrine therapy for NOA should be individualized, phenotype-guided, and closely monitored.
• Testosterone response is a potential prognostic biomarker, not a validated therapeutic target.
• Further investigation within clinical trials is recommended for preoperative endocrine therapy in NOA.