Can spermatozoa be retrieved in non-obstructive azoospermic patients with high FSH level?: A retrospective cohort study

Amer, Medhat; Ahmed, Ahmed Ragab; Hamid, Asmaa Ahmed Abdel; Din, Sameh Fayek GamalEl

doi:10.1111/and.13176

Cited by 21 publications

(13 citation statements)

References 41 publications

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“…We acknowledge that testicular volume is a less valuable variable for the diagnosis of NOA than FSH, but it is also well known that a proportion of NOA men could have normal FSH values 44. This fact was confirmed in a recent study which showed that 14% of NOA men exhibited normal FSH values despite abnormal spermatogenesis 45. The patient's age at orchidopexy was very variable and could have impacted overall outcome.…”

Section: Discussionmentioning

confidence: 62%

Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes

et al. 2019

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Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l −1 vs 19.3 IU l −1 , P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval ( P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.

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Section: Discussionmentioning

confidence: 62%

Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes

et al. 2019

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“…In a study by Kelsey et al [ 14 ], the FSH level had a fair AUC of 0.89 in simply distinguishing azoospermic and non-azoospermic childhood cancer survivors; however, with specificity and sensitivity of 81% and 83%, respectively, in this setting it is doubtful that the FSH level would be able to solve the significantly more delicate task of distinguishing azoospermic patients with focal spermatogenesis. Controversially, some authors have even described a positive association between FSH and the SRR [ 15 ]. We assume that this discrepancy can be resolved if we do not interpret the FSH level as a continuous variable, but rather as a flag of certain testicular phenotypes, such as the one we attempted to describe in this paper.…”

Section: Discussionmentioning

confidence: 99%

Azoospermic men with isolated elevation of follicle-stimulating hormone represent a specific subpopulation of patients with poor reproductive outcomes

Гамидов¹,

Shatylko

Popova

et al. 2022

Clin Exp Reprod Med

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Objective: This study aimed to describe a distinct subpopulation of azoospermic patients with isolated elevation of follicle-stimulating hormone (iFSH) and poor outcomes of microdissection testicular sperm extraction (microTESE).Methods: A retrospective analysis of microTESE outcomes was conducted among 565 patients with non-obstructive azoospermia (NOA). Testicular pathology was assessed by the dominant histological pattern and Bergmann-Kliesch score (BKS). Descriptive statistics were presented for the iFSH subgroup. Inhibin B levels, the sperm retrieval rate (SRR), and BKS were compared in iFSH patients and other NOA patients.Results: The overall SRR was 33.3% per microTESE attempt. The median BKS was 0.6 (interquartile range, 0–2). Of all NOA patients, 132 had iFSH, and microTESE was successful only in 11 of those cases, with an SRR of 8.3%, while the total SRR in other NOA patients was 38.1% (p<0.001). iFSH had a sensitivity of 32.1% (95% confidence interval [CI], 27.4%–36.8%) and specificity of 94.1% (95% CI, 90.8–97.4%) as a predictor of negative microTESE outcomes.Conclusion: Patients with iFSH may harbor a distinct testicular phenotype with total loss of the germ cell population and poor outcomes of surgical sperm retrieval.

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“…The results of the few studies available in this field, however, are not fully able to demonstrate a beneficial effect of hormonal treatment on the SRR in men with NOA. As displayed in Table 2, five studies [34,[55][56][57][58] were carried in NOA men who underwent micro-TESE for the first time, while four [23,51,53,59] enrolled men undergoing salvage micro-TESE. The first two studies evaluated a well-selected cohort of patients, e.g., normogonadotropic men [55] and men with well-defined testis histology (MA and HYPO) [56], therefore, their results have poor generalizability, while the results of Amer and coworkers [58] are weakened by the relatively low overall SRR (32,2%), probably due to differences in skill and experience among the 15 urologists who performed micro-TESE.…”

Section: Hormonal Treatment Before Micro-tesementioning

confidence: 99%

“…As displayed in Table 2, five studies [34,[55][56][57][58] were carried in NOA men who underwent micro-TESE for the first time, while four [23,51,53,59] enrolled men undergoing salvage micro-TESE. The first two studies evaluated a well-selected cohort of patients, e.g., normogonadotropic men [55] and men with well-defined testis histology (MA and HYPO) [56], therefore, their results have poor generalizability, while the results of Amer and coworkers [58] are weakened by the relatively low overall SRR (32,2%), probably due to differences in skill and experience among the 15 urologists who performed micro-TESE. The two largest sample studies [34,57] provided conflicting results, i.e., in the study of Reifsnyder et al [34], SRR did not differed among men with subnormal T levels receiving hormonal treatment (N = 307) or no treatment (N = 41), while in the study of Hussein et al [57], SRR was significantly higher in men receiving hormonal treatment (N = 496) compared to those receiving no treatment (N = 112), and 10.9% of treated patients had sperm in the ejaculate after treatment.…”

Section: Hormonal Treatment Before Micro-tesementioning

confidence: 99%

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

Caroppo

Colpi²

2021

JCM

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Hormonal stimulation of spermatogenesis prior to surgery has been tested by some authors to maximize the sperm retrieval yield in patients with nonobstructive azoospermia. Although the rationale of such an approach is theoretically sound, studies have provided conflicting results, and there are unmet questions that need to be addressed. In the present narrative review, we reviewed the current knowledge about the hormonal control of spermatogenesis, the relationship between presurgical serum hormones levels and sperm retrieval rates, and the results of studies investigating the effect of hormonal treatments prior to microdissection testicular sperm extraction. We pooled the available data about sperm retrieval rate in patients with low vs. normal testosterone levels, and found that patients with normal testosterone levels had a significantly higher chance of successful sperm retrieval compared to those with subnormal T levels (OR 1.63, 95% CI 1.08–2.45, p = 0.02). These data suggest that hormonal treatment may be justified in patients with hypogonadism; on the other hand, the available evidence is insufficient to recommend hormonal therapy as standard clinical practice to improve the sperm retrieval rate in patients with nonobstructive azoospermia.

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Can spermatozoa be retrieved in non-obstructive azoospermic patients with high FSH level?: A retrospective cohort study

Cited by 21 publications

References 41 publications

Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes

Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes

Azoospermic men with isolated elevation of follicle-stimulating hormone represent a specific subpopulation of patients with poor reproductive outcomes

Hormonal Treatment of Men with Nonobstructive Azoospermia: What Does the Evidence Suggest?

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